An anaesthetic job planned representative should attend regular multidisciplinary hip fracture management meetings and feedback any relevant learning points to departments of anaesthesia and individual anaesthetists, as appropriate.
Facilities to provide total hip replacement to hip fracture patients with limited comorbidities should be available seven days a week.
Standard protocols for unilateral fascia iliacus compartment blocks should be readily available and training, awareness and management of local anaesthetic toxicity should be ensured to allow timely delivery in the ED.54
Agreed local guidelines should be in place and implemented on the following:
Departments should develop protocols for reviewing patients with hip fracture postoperatively, to support continuing orthogeriatric care, and to learn from successes and problems as part of continuous quality improvement.45
There should be a preoperative assessment clinic for elective orthopaedic surgery.
The anaesthetist should contribute in the multidisciplinary perioperative care process which focuses on preoptimisation, patient education, standardised enhanced recovery pathways of care aimed at delivering early mobility, discharge, and early return to normal life.46,62 The option of doing nothing should be considered where relevant.63,64
There should be multidisciplinary input for the preoperative assessment of high risk patients such as patients with cognitive disorders, chronic kidney disease, diabetes mellitus and ischaemic heart disease.50,65 The anaesthetist should be involved in preoperative optimisation and prehabilitation plans.60,62
In patients aged over 65, frailty screening using an appropriate validated screening tool should be performed and documented early in the preassessment pathway. A screening tool used in combination with direct questioning should also be adopted to help identify patients with cognitive impairment and therefore increased risk of delirium.66
