Clinical Interventions in Aging (Jul 2024)

Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country

  • Sri-On J,
  • Worawiwat T,
  • Luksameearunothai K,
  • Nirunsuk P,
  • Vanichkulbodee A,
  • Fusakul Y,
  • Phisaiphun K,
  • Kanokkarnjana P,
  • Lerdruttanasoontorn D,
  • Thong-on K

Journal volume & issue
Vol. Volume 19
pp. 1225 – 1233

Abstract

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Jiraporn Sri-On,1 Thitarat Worawiwat,2 Kitchai Luksameearunothai,3 Pornsak Nirunsuk,3 Alissara Vanichkulbodee,2 Yupadee Fusakul,4 Krit Phisaiphun,5 Pornsiri Kanokkarnjana,2 Danaiphat Lerdruttanasoontorn,6 Kwannapa Thong-on1 1Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand; 2Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand; 3Orthopedic Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand; 4Department of Rehabilitation Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand; 5Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand; 6Suankularb Wittayalai School, Phra Nakhon, Bangkok, ThailandCorrespondence: Jiraporn Sri-On, Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand, 681 Samsen road, Dusit, Bangkok, Thailand, 10130, Tel +66 896840010, Email [email protected]: This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures.Patients and Methods: Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs).Results: The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration.Conclusion: The HFFT protocol’s implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.Keywords: older adult, hip fracture fast-track protocol, middle-income country

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