title: Prehospital fast track care for patients with hip fracture: Impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial.
abstract: BACKGROUND
  Ambulance organisations in Sweden have introduced prehospital fast track care (PFTC) for patients with suspected hip fracture. This means that the ambulance nurse starts the pre-operative procedure otherwise implemented at the accident & emergency ward (A&E) and transports the patient directly to the radiology department instead of A&E. If the diagnosis is confirmed, the patient is transported directly to the orthopaedic ward. No previous randomised, controlled studies have analysed PFTC to describe its possible advantages. The aim of this study is to examine whether PFTC has any impact on outcomes such as time to surgery, length of stay, post-operative complications and mortality.
  
  
  METHODS
  The design of this study is a prehospital randomised, controlled study, powered to include 400 patients. The patients were randomised into PFTC or the traditional care pathway (A&E group).
  
  
  RESULTS
  Time from arrival to start for X-ray was faster for PFTC (mean, 28 vs. 145 min; p<0.001), but the groups did not differ with regard to time from start of X-ray to start of surgery (mean 18.40 h in both groups). No significant differences between the groups were observed with regard to: time from arrival to start of surgery (p=0.07); proportion operated within 24h (79% PFTC, 75% A&E; p=0.34); length of stay (p=0.34); post-operative complications (p=0.75); and 4 month mortality (18% PFTC, 15% A&E p=0.58).
  
  
  CONCLUSIONS
  PFTC improved time to X-ray and admission to a ward, as expected, but did not significantly affect time to start of surgery, length of stay, post-operative complications or mortality. These outcomes were probably affected by other factors at the hospital. Patients with either possible life-threatening conditions or life-threatening conditions prehospital were excluded.
authors.affiliation: Department of Ambulance and Prehospital Care, Region Halland, Sweden; Department of Orthopaedics, Lund University, Sweden. Electronic address: glenn.larsson@regionhalland.se.
authors.forename: Glenn
authors.initials: G
authors.lastname: Larsson
authors.affiliation: Department of R&D, Region Halland, Sweden; Department of Cancer Epidemiology, Lund University, Sweden.
authors.forename: Rn Ulf
authors.initials: RU
authors.lastname: Strömberg
authors.affiliation: Department of Orthopaedics, Lund University, Sweden; Skane University Hospital, Malmö, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rogmark
authors.affiliation: Department of Orthopaedics, Lund University, Sweden; Department of R&D, Sahlgrenska University Hospital,Göteborg, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Nilsdotter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D017146:Models, Organizational; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D011872:Radiology Department, Hospital; D013548:Sweden; D013997:Time Factors
keywords: A&E; Hip fracture; Prehospital fast track care; Randomised, Controlled trial; Time to surgery