In phase 1 of the study we aimed to establish best and current practice in acute hospitals for people with hip fracture and dementia leading to the development of an ‘Enhanced Recovery After Surgery’ (ERAS) intervention to optimise care for these patients. We began the process with a systematic review which exposed the lack of good quality evidence across a wide range of components of care.
In the face of the uncertainty around rehabilitation provision and the lack of robust national or international guidelines on how to deliver care to people living with CI following hip fracture, we deployed a range of innovative methods (freedom of information disclosure, telephone survey, focus groups and ethnographic observations on acute wards) to address the problem.
Using these methods we identified 25 key ‘care elements’ as core processes essential to the care of patients with CI and hip fracture. These major elements were mapped to ERAS phases (admission, pre-operative, intra-operative, postoperative, rehabilitation, discharge) and refined at three regional consensus events across Norfolk, East Midlands and Cambridgeshire. These events engaged 30 stakeholders drawn from across the NHS and Service User Advisory Groups who were selected to represent all stages in the patient pathway. Discussions were directed by consensus development methods. This process ensured components of the prototype pathway fitted together to represent the complete patient journey. This work formed the basis of the PERFECTED intervention - the PERFECT-ER checklist.