Background
hip fracture, fracture, dementia, cognitive impairment
SIL
The increasing incidence of dementia is a worldwide public health challenge, requiring multiple strategies including action to improve the quality of healthcare services.In acute settings, over 40% of the people with a hip fracture have cognitive impairment.The PERFECTED research programme was funded by the National Institute for Health Research (NIHR), UK, to develop and test an intervention to enhance the recovery of patients with hip fracture and cognitive impairment on acute wards. PERFECT-ER is a complex multicomponent service improvement intervention which aims to enhance recovery using multiple marginal gains in the quality of care.The PERFECT-ER intervention comprises a structured checklist,
PERFECT-ER is implemented by an SIL, a formally appointed internal implementation lead, a qualified healthcare professional, based day-to-day on the selected ward. They attend a 3-day induction training in intervention delivery. They were supported by a senior doctor acting as a PL to facilitate implementation across the organisation. The checklist, designed to overlay current hip fracture pathways, identifies areas of strength and weaknesses in current practice. It is used to score a sample of patients’ notes (documentary evidence) to determine current practice and identify areas for improvement. Scores are shared with staff at action-planning meetings, where discussions create shared action plans to address lower scoring items. The Plan (action plan), Do (implementation), Study (fill in checklist and assess scores), Act (engage ward staff) cycle then recommences.As part of the wider PERFECTED programme of research, we conducted a process evaluation of the PERFECT-ER feasibility trial.