Development of a Fast-Track Care Model for Patients with Hip Fractures to Reduce Surgical Waiting Time and Complications at Borabue Hospital, Maha Sarakham Province

Abstract

This action research aimed to develop a fast-track care model for patients with hip fractures to reduce surgical waiting time and complications at Borabue Hospital, Maha Sarakham Province.The study was conducted from July 2024 to September 2025 at Borabue Hospital, Maha Sarakham Province, Thailand. The research was based on the action research framework of Kemmis and McTaggart, consisting of four iterative phases: planning, action, observation, and reflection. The participants included 68 patients with hip fractures who underwent surgical treatment and a multidisciplinary healthcare team involved in patient care. The research instruments comprised the BORABUE Hip Fracture Fast Track Model, patient data record forms, complication assessment forms, and a multidisciplinary team satisfaction questionnaire. Quantitative data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation, while qualitative data were analyzed using content analysis.

The findings revealed that: (1) the existing care system was characterized by delays in patient assessment, multidisciplinary coordination, and preoperative preparation, resulting in delayed surgery and increased postoperative complications; (2) the developed BORABUE Hip Fracture Fast Track Model consisted of an emergency department screening system, an orthopedic notification system, a Clinical Pathway, preoperative optimization protocols, operating room management, early rehabilitation, and a continuity of care system through the Intermediate Care (IMC) and Home Health Care teams; and (3) after implementation, the average waiting time for surgery decreased from 94.8 to 56.3 hours, and the average length of hospital stay decreased from 12.4 to 8.1 days. The proportion of patients receiving early rehabilitation within 24 hours after surgery increased from 75.00% to 89.71%, while the proportion of patients discharged within five days after surgery increased from 73.08% to 92.65%. Furthermore, the incidence of postoperative complications, including pneumonia, pressure injuries, urinary tract infections, delirium, and surgical site infections, declined across all indicators. Overall satisfaction among the multidisciplinary team was at the highest level (Mean = 4.69, SD = 0.47). In conclusion, the BORABUE Hip Fracture Fast Track Model is an effective care model for community hospitals. It significantly reduced surgical waiting time, postoperative complications, and length of hospital stay while enhancing multidisciplinary teamwork and improving the quality of care for patients with hip fractures.