Building on evidence from our research and the learning from the stakeholder event we drew up the PERFECT-ER intervention which comprises: a best practice checklist, a staff training manual, and an improvement process to continuously advance the care of this patient group. We then conducted a cluster randomised control trial of PERFECT-ER in 11 hospitals across England and Scotland involved 282 people with hip fracture and CI. We demonstrated successful implementation of the intervention and recruitment to the trial over a period of 15 months. The PERFECT-ER intervention showed signals of improving cognition (MMSE) (1-point improvement) and in-patient hospital survival (1.5 x higher survival).

The process evaluation showed the intervention was welcomed and utilised despite difficulties with staffing levels, bed pressures and frail patients. People in hospital with hip fracture and CI are vulnerable. The PERFECTED study was the first to demonstrate that a large trial involving this population can be successfully conducted in acute hospitals. We also demonstrated that the intervention can be implemented and may have the potential to improve outcomes.

Link: PERFECTED enhanced recovery (PERFECT-ER) care versus standard acute care for patients admitted to acute settings with hip fracture identified as exper ) iencing confusion: study protocol for a feasibility cluster randomized controlled trial - PubMed (nih.gov

Link: P4‐386: PERI‐OPERATIVE ENHANCED RECOVERY HIP FRACTURE CARE OF PATIENTS WITH DEMENTIA (PERFECTED): RCT RESULTS - Fox - 2019 - Alzheimer's & Dementia - Wiley Online Library