30-day readmission risk after hip fracture: a qualitative study in the Midlands, United Kingdom

Background
Reducing unplanned 30-day readmission is imperative across health systems; particularly if they result from clinical failings, avoidable harms and are associated with unnecessary expenditure.
This study aimed to identify interventions capable of reducing avoidable 30-day readmission after fragility fracture of the hip in an area of high socio-economic deprivation in the United Kingdom (UK) and understand how these interventions could be informed by behaviour change theory.

Methods
A qualitative study was undertaken in the Midlands region of the UK in the National Health Service. Observational fieldwork of healthcare staff meetings, interviews with patients following hip fracture, carers and staff, and a theoretical mapping exercise were undertaken to examine patient’s journeys and factors affecting service delivery that might impact readmission risk. Observations were documented using electronic field notes. Semi-structured interviews explored experiences of the admission/readmission, transitions in care, readmission risks and interventions capable of reducing avoidable readmission. Analysis was conducted in four parts: 1) Inductive thematic analysis of interview and observational data explored patient journeys 2) Dyadic interviews analysis examined agreement/divergence within accounts 3) Deductive analysis identified readmission risk factors and candidate interventions 4) Candidate interventions were mapped with the constructs of the Theoretical Domains Framework. UK REC and HRA approval was obtained 3/WM/0242.

Results
Eleven non-participant observations were conducted in healthcare staff meetings in community (3) and acute (8) settings. Twenty-Four interviews were completed with 11 staff (five occupational therapists, three physiotherapists, one doctor, one trainee nurse practitioner, and one physiotherapy assistant), eight patients and five of the patients’ carers during July-September 2024. Three high level themes were identified – perceived burden, communication challenges and the health and social care system. Twenty-two candidate interventions relating to four challenges were identified: 1) adequacy of information, 2) individualised care, 3) access to services and 4) the hip fracture pathway.

Conclusions
This study identified interventions which staff, patients and carers proposed might reduce avoidable readmission after hip fracture in an area of high deprivation. Further work is needed to refine and rank the proposed interventions followed by an implementation plan to explain mode of delivery and who needs to do what differently.