Quality and Safety Service Model in Spinal Anesthesia for Elderly Hip Fracture Patients Under Fast Track Pathway

Abstract

Purposes:  To study the situational problems, and to develop and evaluate the outcomes of quality and safety service model in spinal anesthesia for elderly hip fracture patients under fast track pathway.

Study design: Research and Development.

Material and Methods: The sample for this study consisted of elderly patients undergoing spinal anesthesia and 30 registered nurses practicing in the operating room of the Anesthetic Nursing Department at Roi Et Hospital. The research was conducted from December 2025 to August 2026. The research instruments comprised two main categories: Experimental Instrument: A nursing care model for elderly patients with hip fractures receiving spinal anesthesia. Data Collection Instruments: A general demographic questionnaire, an anesthetic monitoring and data record form, a clinical outcome record form, an evaluation form for compliance with fast-track process indicators, and a qualitative concordance assessment form. Statistical Analysis Data were analyzed using descriptive statistics, paired t-test, Univariable analysis and Multivariable analysis. p<.05

Main finding: 1) The challenges encountered in nursing care for elderly patients with hip fractures undergoing fast-track surgery include complex comorbidities that require significant time for nurse anesthetists and physicians to perform preoperative evaluations, a shortage of dedicated nurse anesthetists for fast-track cases, and an excessive workload exceeding staffing capacity. 2) The developed nursing care model for elderly patients with hip fractures undergoing fast-track surgery comprises four main phases: (1) the preoperative phase, aimed at assessing readiness and preparing patients for surgery within 24 to 48 hours; (2) the intraoperative and anesthetic phase, designed to minimize surgical time and enhance intraoperative safety; (3) the postoperative phase, focused on accelerating recovery and preventing complications; and (4) the discharge planning and continuous care phase, intended to prevent secondary fractures and facilitate the restoration of optimal quality of life. 3) A comparison of compliance scores with the fast-track clinical practice guidelines before and after the implementation of the nursing model revealed a statistically significant difference (p < .05). Prior to the implementation, the compliance score was 4.50 (SD. = 1.25), whereas post-implementation, the score increased to 5.73, representing a difference of 1.23 points (95%CI:  0.726, 1.739). Similarly, the qualitative concordance scores before and after the development of the model demonstrated a statistically significant difference (p < .05). The mean score prior to model development was 7.73 (SD. = 1.04), which increased to 9.00 (SD. = 0.00) following model development, indicating a difference of 1.26 points (95%CI:  0.875 – 1.658).

Conclusion and recommendations: The nursing care model for elderly patients with hip fractures undergoing fast-track surgery provided clear clinical nursing guidelines and effectively enhanced the achievement of quality and safety indicators.