Impact of Care Delivered in Nondesignated Areas on Older Patients Admitted With Hip Fractures: A Quality Improvement Initiative

Background

Although testimonies of devastating impacts of care delivered in nondesignated hospital areas (corridor care) are mounting, there is a paucity of quantitative data. This study aimed to assess the associations between: (1) care in nondesignated areas and key performance indicators (KPIs), including ward moves and length of stay (LOS); and (2) between KPIs and mortality.

Methods

Data from this cross-sectional study were derived from the National Hip Fracture Database audit programme (a quality-improvement initiative commissioned by the Healthcare Quality Improvement Partnership, NHS England). In total, 508 patients (65% women) consecutively admitted with hip fractures (January 2024–January 2025) were included. The duration (h:min) of care in nondesignated areas was categorised by tertiles (< 1:20; 1:20–4:20; > 4:20). Associations between variables were determined by logistic regression, presented as odds ratios (OR) and 95% confidence intervals.

Results

Patients cared for in nondesignated areas (11%) and bed care patients (89%) had similar clinical characteristics (median age = 85.5 years). Care in nondesignated areas varied inversely with seasonal average local temperatures: 10.7% in summer (22.5°C), 19.6% autumn (15.9°C), 44.6% winter (8.6°C), and 25.0% spring (14.9°C), which was more discernible than the corresponding distribution of bed care: 21.2%, 23.7%, 25.9% and 29.2%. Compared with bed care patients, those cared for in nondesignated areas for ≥ 1 h:20 min were associated with ≥ 3 ward moves: OR = 4.02 (1.61–10.06). LOS on orthogeriatric wards for bed care patients was 13.4 days, and care in nondesignated areas > 4 h:20 min was 17.2 days, which increased to 19.7 days for all patients cared for in nondesignated areas with ≥ 3 ward moves. In turn, higher in-hospital mortality was associated with multiple ward moves: OR = 2.63 (1.23–5.66) and prolonged LOS: OR = 3.23 (1.53–6.81).

Conclusions

The impact of care delivered in nondesignated areas exposed by KPIs is consistent with testimonies from patients and NHS staff. This evidence serves as a stimulus to take urgent action to abolish care in nondesignated areas.