Abstracts / Injury Extra 40 (2009) 183–235 205 5A.5 Hip fractures: Does the age influence acute hospital stay, time delay to surgery and acute care costs? R. Verma ∗ , A. Rigby, C. Shaw, A. Mohsen Hull Royal Infirmary, UK Introduction: Population in the UK is ageing. A number of studies have shown that advancing age is associated with increased length of hospital stay after hip fracture surgery. Equally some studies have shown that the mean length of stay on the acute orthopaedic ward is not significantly different between age groups. The primary aim of our study was to compare stay in acute orthopaedic wards and time delay to surgery with increasing age in patients with hip fracture. Our secondary aim was to see if there were any additional cost implications for acute care of hip fractures with increasing age. Patients and methods: All adult patients with hip fractures are entered into a prospective database. The data analysed included age, sex, type of housing, date of admission and date of operation, delay in surgery, American Society of Anaesthesiology (ASA) grade, acute hospital stay, pre-fracture mobility, medical co-morbidities (specifically chest infection, heart disease, congestive heart failure, past cerebrovascular accident, deep vein thrombosis and pul- monary embolism). Patient’s age was recoded into six groups: <60 years, 60–69 years, 70–79 years, 80–89 years, 90–99 years and ≥100 years. Results: A total of 3712 patients presented for 3953 operations for fractured neck of femur between October 2000 and March 2008. As age increased, so did mean acute stay in orthopaedic ward and surgical delay. Mean stay in acute ward increased from 12.4 days in <60 years to more than 21 days in 90–99 year age group (p < 0.001). Similarly the cost of acute stay increased with increasing age. Conclusions: Acute care of hip fractures in with increasing age poses a challenge. Our paper demonstrates that we need more resources to tackle the problems associated with ageing population. Keywords: Fracture NOF; Increasing age; Acute stay doi:10.1016/j.injury.2009.06.225 5A.6 A multi-centre evaluation of the Fast Track process for patients with a diagnosis of fractured neck of femur: Is it safe, effective and quick? B. Ollivere a,∗ , R. Brankin b , C. Darrah a , N. Chirodian a , M. Wood b , J. Wimhurst a a Norfolk & Norwich University Hospital NHS Trust, UK b West Suffolk Hospital NHS Trust, UK Fast Track care for fractured neck of femur patients is a well established pathway for rapid admission of patients through A&E. The system was initially introduced to alleviate the waiting time pressures in A&E but promoted as an improvement in quality of care. However, it has not been evaluated since the introduction of “hospital at night” which has added additional pressures to the receiving teams. A prospective, two-centre study was undertaken to evaluate the current standards of care for patients attending the A&E depart- ments with a suspected diagnosis of fractured neck of femur. These were compared to an age-matched control group with other long bone fractures who were not Fast Tracked but referred to the orthopaedic team whilst in A&E. Outcome measures included missed medical diagnosis, analgesia, fluid administration, medical hand over and correct initial diagnosis. Table 1 Standards of medical care provided to the study and control groups. Study Control P value Number 73 18 Correct diagnosis 98% 100% >0.05 Missed underlying medical pathology 21% 0% =0.035 Analgesia administered 57% 93% =0.002 Fluid resuscitation started 37% 100% =0.001 ECG taken 84% 93% >0.05 Hand over to orthopaedic team 10% 100% =0.001 Over a three-month period, 73 patients were recruited to the study group, and 18 to the control group. The Fast Track group had significantly higher rates of missed medical diagnosis, lower rates of pain relief and fluid resuscitation on admission to the ward than the control group (Table 1). The time to administration of basic medical care was significantly higher in the Fast Track group. Following the results of this study, the Fast Track protocol was replaced with a Streamed Care Pathway based on physiological and outcome scoring in A&E. This has significantly improved all out- come measures. We recommend that all fractured neck of femur patients should be treated based on their individual physiological status with a Streamed Care Pathway. Indiscriminate Fast Tracking of these patients leads to a poor standard of care. Keywords: Proximal femoral fractures; Fast Track doi:10.1016/j.injury.2009.06.226 5A.7 Lean thinking: A value stream approach for improving care of hip fracture patients D. Chakrabarti a,b,∗ , T. Yousri a,b , Z. Khan a,b , R.J. Fernandes a,b , K.H.A. Wahab a,b a Good Hope Hospital, UK b Heart of England NHS Trust, UK Introduction: LEAN strategy which is derived mostly from the Toyota production system is now an emerging concept adopted by many organizations, including the National Health Service, in an attempt to optimize the use of available resources and improve the quality of services provided. This study aims to evaluate the impact of LEAN thinking application on the care of hip fracture patients. Materials and Methods: Study included hip fracture patients admit- ted prior to application of LEAN from September 2005 to August 2006, who were compared with those admitted post-LEAN from September 2006 to August 2007. Data collected included age, sex, type of fracture and operation, Door to theatre time (DT), length of hospital stay and mortality, with a particular attention to the patients’ 30 days mortality. Results: A retrospective study of 518 hip fracture patients over a two- year period. Post-LEAN strategy application, the results in terms of the mortality rate and DT time were quiet impressive. Patients’ 30 days mortality was noticeably reduced by 42.58% and the overall mortality during hospital stay was significantly reduced by 45.1%. In terms of DT time, 80.94% of patients went to theatres within 48 h. Discussion: LEAN thinking for the hip fracture patients focuses on improving the smoothness of the patients’ flow from the time of their admission until they are discharged. Mapping the stream of patients allows identification of different problems in the path- way, cutting down on the steps which are identified as waste, thus improving the quality of care optimizing the use of available resources. Following the National Hip Fracture database guide- lines, the stream is monitored by looking into door-to-theatre (DT)