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Peri-operative enhanced recovery hip fracture of patients with dementia


How will PERFECTED work?

PERFECTED is comprised of four work packages that will be 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 will work with patients, carers and clinicians from across East Anglia, Nottinghamshire, Yorkshire, London and Scotland to develop and refine the ERP, creating guidelines for its use and bespoke training materials for its implementation. We will then conduct a pilot study in hospitals across the UK to assess the feasibility of procedures and provide information to inform a definitive trial. Patient and Public Involvement is a key component of the study and across the duration of the study members of the public will be involved both as part of the steering group and as part of Service User Advisory Groups.

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

The study is made up of four work packages:

Work Package 1 - Establishing Best Practice

The aim of the first work package is to find out about existing practice for people with dementia who break their hip. This will be carried out in several phases which include: 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 will be involved in carrying out observations in hospital, interviews and focus groups.

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

In this work package we will carry out Action research whereby the initial Enhance Recovery Pathway will be tried out in ward environments. This will be a process of development of the ERP to see what actually works in real life wards.

Work Package 3 - Pilot Study of Enhanced Recovery Pathway

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

Work Package 4 - Consensus Conference and dissemination of findings

In the last work package there will be a consensus conference to discuss the outcomes of the study and findings will be disseminated in a variety of forums including service user outputs, peer reviewed journals and conference presentations.