Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia
Despite one quarter of acute NHS hospital beds being occupied by people with dementia, there is little research on how best to look after these people in hospital. They are exceptionally vulnerable and at high risk of serious complications.
Researchers at the University of East Anglia, with national and international collaborators, are working with a wide range of stakeholders (health professionals, people living with dementia and their carers) to optimise acute hospital care. The Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia programme (PERFECTED) is aiming to improve hospital care for patients living with dementia who break their hip.
We want to find out how to optimise the care and rehabilitation of people with dementia who break their hip by creating an Enhanced Recovery Pathway – a way of helping patients recover quicker after surgery. Through working together, health professionals, people living with dementia, and their carers and researchers will create and pilot the pathway to see how optimising care can improve outcomes, both for this patient group and those who care for them.
How will PERFECTED work?
PERFECTED is comprised of four work packages that will be drawn together to create and evaluate the Enhanced Recovery Pathway (ERP). Using examples of best practice from across the globe, our team of national and international experts will work with patients, carers and clinicians from across East Anglia, Nottinghamshire, Yorkshire, London and Scotland to develop and refine the ERP, creating guidelines for its use and bespoke training materials for its implementation.
We will then conduct a pilot study in hospitals across the UK to assess the feasibility of procedures and provide information to inform a definitive trial. Patient and Public Involvement is a key component of the study and, across the duration of the study, members of the public will be involved as part of the steering group and as part of Service User Advisory Groups.
The study is made up of four work packages:
Work Package 1 - establishing best practice
The aim of the first work package was to find out about existing practice for people with dementia who break their hip. This was carried out in several phases: a systematic review of research literature; surveys in England and internationally; observations of care carried out on hospital ward and A & E; interviews and focus groups with patients, carers and professionals and the development of of an initial Enhanced Recovery Pathway. Lay researchers were involved in carrying out observations in hospital, interviews and focus groups.
Work Package 2 - Optimising care for patients with dementia and hip fracture
In this work package we conducted Action research whereby the initial Enhanced Recovery Pathway was tried out in ward environments. The aim of this work package was to see what actually works in real life.
Work Package 3 - Pilot study of Enhanced Recovery Pathway
This work package is currently in progress. The work package involves piloting the Enhanced Recovery Pathway in a cluster randomised controlled trial which compares the use of Enhanced Recovery Pathway versus Usual Care. It also involves interviews and focus groups with key stakeholders. The aim is to ascertain how feasible the procedures are and to gather information which would inform a definitive trial.
Work Package 4 - Consensus Conference and dissemination of findings
In the last work package there will be a consensus conference to discuss the outcomes of the study. Findings will be disseminated in a variety of forums including service user outputs, peer reviewed journals and conference presentations.
Gill, N., Hammond, S. P., Cross, J., Smith, T., Lambert, N. and Fox, C. (2017) Optimising care for patients with cognitive impairment and dementia following hip fracture. Z Gerontol Geriat. doi: 10.1007/s00391-017-1224-4. Available from link.springer.com.
Hammond, S.P., Cross, J.L., Poland, F.P., Patel, M., Penhale, B., Smith, T.O. and Fox, C. (2016) Freedom of Information Act: scalpel or just a sharp knife? Journal of Medical Ethics. doi:10.1136/medethics-2016-103609. Available from jme.bmj.com.
Smith, T., Hameed, Y., Cross, J., Sahota, O. and Fox, C. (2013) Assessment of people with cognitive impairment and hip fracture: a systematic review and meta-analysis. Archives of Gerontology and Geriatrics. doi: 10.1016/j.archger.2013.04.009 Available from sciencedirect.com.
Smith, T., Hameed, Y., Henderson, C., Cross, J., Sahota, O. and Fox, C. (2013) Effectiveness of post-operative management strategies for adults with dementia following hip fracture surgery, In: The Cochrane Collaboration. Available from onlinelibrary.wiley.com.
Patel, M., Lee, S., Hammond, S.P. and Fox, C. Contributors: Donaldson, D., Cross, J., Poland, F., Smith, T., Penhale, B., Lambert, N., Varley, A. and Backhouse, T. European Geriatric Medicine International Congress (EUGMS) (Oct 2016) "Caring for people with hip fracture and cognitive impairments: qualitative findings from the PERFECTED Research Programme" PDF
Backhouse, T., Lambert, N., Varley, A., Hammond, S.P., Henderson, C., Harris, E., Vanhegan, S., Caswell, A., Poland, F., Smith, T., Penhale, B., Cross, J. and Fox, C. Alzheimer's Society Annual Conference, Manchester (June 2015) "An observational study of acute hospital care to inform a recovery pathway for hip-fracture patients with dementia" PDF
Fox, C., Lambert, N., Poland, F., Cross, J., Sahota, O., Teale, E., Donell, S., Penhale, B., Smith, T., Hammond, S.P., Backhouse, T. and Varley, A. Alzheimer's Society Conference, Nottingham (July 2014) "Designing a hospital observational study involving lay researchers: the methodological challenges" PDF
- Dr Chris Fox, Norwich Medical School, UEA
The Core Team
Dr Simon P Hammond, Programme Manager and Research Fellow, Norwich Medical School, UEA
Dr Vicki McDermott-Thompson, Research Associate, Norwich Medical School, UEA
Nick Leavey, Trial Manager, Norwich Medical School, UEA
Greg Howard, Clinical Trial Assistant, Norwich Medical School, UEA
Dr Nigel Lambert, Visitor, School of Health Sciences, UEA
Anna Varley, Research Associate in Process Evaluation, School of Health Sciences, UEA
Professor Fiona Poland, School of Health Sciences, UEA
Dr Jane Cross, School of Health Sciences, UEA
Bridget Penhale, School of Health Sciences, UEA
Professor Lee Shepstone, Norwich Medical School, UEA
Professor Simon Donell, Norfolk and Norwich University
Professor Stephen Jackson, King’s College
Professor Opinder Sahota, University of Nottingham
Professor Martin Knapp, London School of Economics
Professor Alasdair MacLullich, University of Edinburgh
Professor Clive Ballard, King’s College London
Professor Justin Waring, Nottingham University
Professor John Young, Bradford Teaching Hospitals NHS Foundation Trust
Dr John Holmes, Leeds University
Professor Robert Howard, King's College London
Jo Walmsley, Norfolk and Norwich University Hospital NHS Foundation Trust
The research is funded by the National Institute for Health Research (NIHR) through their Applied Research Programme.
NHS Study Partners:
Dementia Specific Study Partners
University Study Partners