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Schultz EA, Welch JM, Cross W, Shah K, Mansuripur PK, Kain M, Holte P, Lee BJ, Burn M, Hall K, Willey M, McKee M, Pang E, DeBaun M, Douglass N, Egol K, Laverty D, Miller AN, Jeray K, Schenker M, Cannada LK, Hernandez G, Mehta S, Wustrack R, Mitchell A, Morshed S, Gardner M, Morris A, Baker L, Shapiro LM, Sox-Harris A, Kamal RN. Drivers of Delayed Time to Surgery for Hip Fracture Patients: A Multi-Center Qualitative Study. The Journal of The American Academy of Orthopaedic Surgeons. 2025 Aug 4 DOI: 10.5435/JAAOS-D-25-00076.
Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects. INTRODUCTION: Delays in time to surgery (TTS) for patients with a hip fracture negatively affect patient outcomes, including mortality. Surgery within 24 to 48 hours of admission for a hip fracture markedly reduces these risks; however, attempts at improving TTS after hip fracture have had mixed results. Drivers of delays in TTS across different settings in the United States are not well described. Therefore, the aim of this study was to identify drivers of delays in TTS for patients with a hip fracture from different settings to inform where patient- and context-specific improvements in TTS may be implemented. METHODS: Semistructured interviews were completed using the Consolidated Framework for Implementation Research and Theoretical Domains Framework. Interviews were completed with stakeholders involved in hip fracture care between June 2023 and October 2023. Transcripts were analyzed iteratively through a combined inductive and deductive approach. The data were analyzed to synthesize overarching themes related to drivers of delays of TTS. RESULTS: A total of 25 stakeholders, 24 orthopaedic surgeons, and 1 nurse practitioner, from 22 different hospital systems across the United States participated in semistructured interviews. Eight themes of drivers of delayed TTS emerged: (1) patient health; (2) structural drivers of health; (3) care coordination; (4) prioritization; (5) improvement climate; (6) availability; (7) incentive structure; and (8) empowerment. CONCLUSION: Eight major themes related to drivers in TTS for patients with a hip fracture were identified across hospital systems. These findings inform the process of identifying site-specific drivers of delayed TTS at individual health systems and implementing targeted improvement programs for TTS for patients with a hip fracture.
