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Peri-operative enhanced recovery hip fracture of patients with dementia


How will PERFECTED work?

PERFECTED was comprised of four work packages that were drawn together to create and evaluate the Enhanced Recovery Pathway (ERP). Using examples of best practice from across the globe, our team of national and international experts worked with patients, carers and clinicians from across East Anglia, Nottinghamshire, Yorkshire, Lond, and Scotland to develop and refine the ERP, creating guidelines for its use and bespoke training materials for its implementation. We then conducted a pilot study in hospitals across the UK to assess the feasibility of procedures and provide data to inform a definitive trial. Patient and Public Involvement was a key component of the study and across the duration of the study members of the public were involved both as part of the steering group and as part of Service User Advisory Groups.

This was the first dementia-specific study combining the most feasible and effective elements of best care with a formal implementation system. Based on a detailed evaluation of this pilot study, we were able to develop a definitive package for testing in a future major clinical trial.

The study was made up of four work packages:

Work Package 1 - Establishing Best Practice

(November 2013 - July 2015)

The aim of the first work package was to find out about existing practice for people with dementia who break their hip. This was carried out in several phases which included: a systematic review of research literature; surveys in England and Internationally; observations of care carried out on hospital wards and A & E; interviews and focus groups with patients, carers and professionals and the development of an initial Enhanced Recovery Pathway. Lay researchers were involved in carrying out observations in hospital, interviews and focus groups.

Work Package 2 - Optimising care for patients with dementia and hip fracture

(August 2015 - August 2016)

In this work package, we carried out Action Research, whereby the initial Enhance Recovery Pathway was trialed in ward environments. This was a process of development of the ERP to see what actually worked in real-life wards.

Work Package 3 - Pilot Study of Enhanced Recovery Pathway

(August 2016 - September 2018)

This work package was about piloting the Enhanced Recovery Pathway in a cluster randomised controlled trial, which compared the use of the Enhanced Recovery Pathway versus Usual Care. It also involved interviews and focus groups of key stakeholders. The aim was to ascertain how feasible the procedures were and to gather information which will inform a definitive trial.

Work Package 4 - Dissemination of Findings & Next Steps

(August 2018 - January 2019)

In the last work package, findings will be disseminated in a variety of forums including service user outputs, peer-reviewed journal articles, and conference presentations (find a list of our project outputs to date via our publications page). We will also be preparing lay summaries of academic findings, to provide insights from the project to new audiences.