Implementation of the HIP ATTACK Protocol Significantly Decreased Time to Surgery and Physical Therapy Evaluation for Hip Fracture Patients.

Abstract

Objectives: To determine if implementation of the HIP ATTACK protocol for hip fracture patients decreased delays in surgical fixation or postoperative mobilization. The primary hypothesis was that implementation of the HIP ATTACK protocols would improve time to surgery and time to mobilization.

Methods:

Design: This was a retrospective review of patients who underwent hip fracture surgery between January 2011 and January 2021.

Setting: A single academic institution where HIP ATTACK protocols were implemented in September 2016.

Patient selection criteria: Patients >50 years undergoing surgery for treatment of hip fractures (AO 31A1.2-3, 31A2-3, 31B1-3, 32A-C).

Outcome measures and comparisons: Time of diagnosis defined as the time of the initial presenting radiograph and time of mobilization defined as the time the patient stood at edge of bed with physical therapy (PT) were determined. Average values before and after implementation of the HIP ATTACK protocol were compared using a Student t test with a P = 0.05 set as the level of significance for each.

Results: A total of 781 patients were included in the analysis. There were 395 patients who had surgery before September 2016 (average age, 79 years; range 50-102 years; 267 women and 187 men), and 386 patients who were operated on after HIP ATTACK implementation (average age, 77 years; range 50-102 years; 232 women and 95 men). Compared with prior years, implementation of HIP ATTACK was associated with decreased time from diagnosis to surgery by an average of 8 hours (30 vs. 22 hours, P < 0.0001) and decreased time from surgery to PT evaluation by an average of 3 hours (30 vs. 27 hours, P = 0.049). Time from surgery to mobilization was not significantly different before and after HIP ATTACK implementation (59 vs. 58 hours, P = 0.63).

Conclusions: Implementation of the standardized HIP ATTACK protocol by a multidisciplinary team was associated with improvement in time to surgery and PT evaluation. A standardized, multidisciplinary protocol can minimize delay in caring for patients with hip fractures and is critical in limiting morbidity and mortality.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.