Table 4.
Compliance with evidence-based organization of care pathway recommendations for obstetric deliveries and hip fracturea
| Item | n (%), full compliance | Average country range (%) |
|---|---|---|
| Obstetric deliveries (n = 72) | ||
| 1.A structured, accurate record of all events during the antenatal childbirth and postnatal periods is maintained for every woman and child | 66 (91.6) | 58.3–100.0 |
| 2. All women who have epidural analgesia or an operative delivery have their pain assessed using a pain assessment tool approved by the hospital | 42 (58.3) | 8.3–100.0 |
| 3. There is prompt access to ultrasound facilities with trained staff | 72 (100) | 100.0–100.0 |
| 4. There is a procedure that guarantees that all women who are identified in the screening program as at risk of rhesus disease are properly managed | 44 (61.1) | 25.0–100.0 |
| 5. Each woman receives one-to-one midwifery care from a trained midwife during established labor and childbirth | 63 (87.5) | 0.0–100.0 |
| 6. Epidural analgesia is available at all times | 61 (84.7) | 58.3–100.0 |
| 7. Adult intensive care facilities and specialist medical back-up are available onsite | 70 (97.2) | 90.9–100.0 |
| 8. Patient monitoring equipment and clinical expertise in its management are available within the obstetric unit | 71 (98.6) | 91.7–100.0 |
| 9. There is a system in place to ensure that anesthetic and theater services respond within 30 min to obstetric emergencies and expedite delivery in the event of maternal or fetal compromise | 69 (95.8) | 83.3–100.0 |
| 10. All babies are clinically examined prior to discharge from hospital and/or within 72 h of birth by a suitably qualified healthcare professional | 71 (98.6) | 90.9–100.0 |
| Overall score, mean (SD) | 3.7 (0.3) | |
| Hip fracture (n = 74) | ||
| 1. The guidelines require that medical staff assess patients suspected of having a fractured hip within 1 h of arrival in the emergency department or of the incident if the patient was already in hospital | 27 (36.4) | 0.0–75.0 |
| 2. The guidelines require a multidisciplinary assessment plan and individual goals for rehabilitation to be documented within 24 h postoperatively | 16 (21.6) | 0.0–75.0 |
| 3. Magnetic resonance imaging (MRI) is immediately available if hip fracture is suspected, despite negative plain X-rays | 40 (54.0) | 0.0–100.0 |
| 4. The guidelines require that all patients presenting with a fragility (pathological) fracture are managed on a ward with routine access to orthogeriatric medical support | 14 (18.9) | 0.0–75.0 |
| 5. Whenever clinically appropriate, surgery is performed within 48 h of admission | 45 (60.8) | 33.3–100.0 |
| 6. Guidelines require that all patients undergoing hip fracture surgery receive antibiotic prophylaxis | 51 (68.9) | 0.0–100.0 |
| 7. Guidelines require that, if the patient's overall medical condition allows, mobilization begins within 24 h postoperatively | 28 (37.8) | 0.0–75.0 |
| Overall score, mean (SD) | 2.3 (1.0) | |
aMinimum–maximum percentage of fully compliant hospitals by country used to determine country range.