Patient Safety and Complex Care.

Elderly patients with a hip fracture are the focus of the research program ‘Patient Safety and Complex Care’. It is hypothesized that an improvement in the handover process, a more active role for the patient in the care process and evidence based information for the period after discharge can reduce the rate of unintended events and avoidable harm in this patient group. Patients will be randomly assigned to one of four intervention groups, the control group will receive no interventions. During one year a maximum of 500 patients will be included in the study, the patients have to be 65 years or older and have an acute hip fracture. Pathological fractures, patients who receive no surgery for the fracture, patients participating in other (interfering) intervention studies and patients suffering from dementia will be excluded from the study. The effectiveness of the intervention program will be measured through observations, patient record review and interviews with patients. Primary outcome measures are avoidable harm, mortality rate, unintended events and functional mobility.

The rate of unintended events and avoidable harm for elderly hip fracture patients can be reduced by the introduction of three integrated interventions directed at the structure of the handover process, the role of the patient in the care process and evidence based information for the period after discharge.

- Baseline measurement


- Final measurements (record review six months after discharge, interview with patients (by telephone) two weeks and six months after discharge

Interventions

- SBAR communication tool to structure handover process

- Patient safety card

- Bundles with evidence based recommendations for the period after discharge



There are four different intervention groups (the patients will be randomly assigned to one of the four intervention groups):

Group 1: SBAR

Group 2: SBAR and patient safety card

Group 3: SBAR and bundles

Group 4: SBAR, patient safety card and bundles


Control group: receives no interventions



At least 100 patients per group will be included