Fast track hip trial: an evaluation of a change in X‐ray referral

The purpose of this trial was to establish whether a change in the X‐ray referral procedure would reduce the time between presentation and admission for patients who attended a busy Accident and Emergency department with a fractured neck of femur. This group of patients was selected because they are susceptible to decubitus ulcers, the development of which may relate to the time spent on a trolley. Senior nurses in the Accident and Emergency department were educated in patient assessment and management, and knowledge and implementation of ionising radiation regulations. They then referred patients who presented with suspected fractures of the femoral neck to the radiology department within agreed guidelines and without a doctor's examination. Records were kept over a 3‐month trial period. A total of 27 completed cases were recorded and the data included radiological findings, total time from presentation to arrival on the ward or discharge, total time waiting for a porter and being transported, total time spent in the radiology department, and whether the patient reattended for a further X‐ray examination. We concluded that the change in X‐ray referral procedure resulted in an appreciable reduction in the overall time between presentation and admission. However, it was not possible to draw any valid conclusions regarding any reduction in decubitus ulceration as a result of this speedier diagnosis and admission.