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

Hammond, Simon P. ORCID: https://orcid.org/0000-0002-0473-3610, Cross, Jane L. ORCID: https://orcid.org/0000-0002-7003-1916, Shepstone, Lee, Backhouse, Tamara ORCID: https://orcid.org/0000-0001-8194-4174, Henderson, Catherine, Poland, Fiona ORCID: https://orcid.org/0000-0003-0003-6911, Sims, Erika, MacLullich, Alasdair, Penhale, Bridget ORCID: https://orcid.org/0000-0002-8487-0606, Howard, Robert, Lambert, Nigel, Varley, Anna, Smith, Toby O. ORCID: https://orcid.org/0000-0003-1673-2954, Sahota, Opinder, Donell, Simon, Patel, Martyn, Ballard, Clive, Young, John, Knapp, Martin, Jackson, Stephen, Waring, Justin, Leavey, Nick, Howard, Gregory ORCID: https://orcid.org/0000-0001-5749-0782 and Fox, Chris ORCID: https://orcid.org/0000-0001-9480-5704 (2017) PERFECTED enhanced recovery (PERFECT-ER) care versus standard acute care for patients admitted to acute settings with hip fracture identified as experiencing confusion: study protocol for a feasibility cluster randomized controlled trial. Trials, 18. ISSN 1745-6215

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Abstract

Background: Health and social care provision for an ageing population is a global priority. Provision for those with dementia and hip fracture has specific and growing importance. Older people who break their hip are recognised as exceptionally vulnerable to experiencing confusion (including but not exclusively, dementia and/or delirium and/or cognitive impairment(s)) before, during or after acute admissions. Older people experiencing hip fracture and confusion risk serious complications, linked to delayed recovery and higher mortality post-operatively. Specific care pathways acknowledging the differences in patient presentation and care needs are proposed to improve clinical and process outcomes. Methods: This protocol describes a multi-centre, feasibility, cluster-randomised, controlled trial (CRCT) to be undertaken across ten National Health Service hospital trusts in the UK. The trial will explore the feasibility of undertaking a CRCT comparing the multicomponent PERFECTED enhanced recovery intervention (PERFECT-ER), which acknowledges the differences in care needs of confused older patients experiencing hip fracture, with standard care. The trial will also have an integrated process evaluation to explore how PERFECT-ER is implemented and interacts with the local context. The study will recruit 400 hip fracture patients identified as experiencing confusion and will also recruit “suitable informants” (individuals in regular contact with participants who will complete proxy measures). We will also recruit NHS professionals for the process evaluation. This mixed methods design will produce data to inform a definitive evaluation of the intervention via a large-scale pragmatic randomised controlled trial (RCT). Discussion: The trial will provide a preliminary estimate of potential efficacy of PERFECT-ER versus standard care; assess service delivery variation, inform primary and secondary outcome selection, generate estimates of recruitment and retention rates, data collection difficulties, and completeness of outcome data and provide an indication of potential economic benefits. The process evaluation will enhance knowledge of implementation delivery and receipt.

Item Type: Article
Uncontrolled Keywords: dementia,hip fracture,feasibility,acute care,hospital,service improvement
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life
Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Faculty of Medicine and Health Sciences > Research Groups > Mental Health
Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Faculty of Social Sciences > Research Centres > Centre for Research on Children and Families
Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Centres > Institute for Volunteering Research
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
Depositing User: Pure Connector
Date Deposited: 16 Nov 2017 06:06
Last Modified: 19 Oct 2023 02:06
URI: https://ueaeprints.uea.ac.uk/id/eprint/65468
DOI: 10.1186/s13063-017-2303-y

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