Background and purpose: As hip fracture patients are common and constitute an increasing health problem it is important to use available resources effectively and provide high quality care. Correct treatment can start in the ambulance with administration of oxygen, pain relief and intravenous glucose liquid according to the Lean Production concept. The basis of Lean Production is that the employees themselves develop their work as a natural part of the job. In the case of health care, this involves learning what it are that really benefits the patients, what it is that creates added value. Anything that does not benefit the patients is to be removed.

The aim of this study was to improve the preopera-tive care of hip fracture patients.

Subjects : During the period 2007-04-01 to 2007-12-31 totally 365 hip fracture patients were consecutively admitted to the University Hospital. Of them 117 (mean age 82.8) patients were included in the project and 248 patients (mean age 81.3) were controls.

Method: Patients with a suspected hip fracture (shortened and externally rotated leg) were supposed to be included in the study. Exclusions criteria were medical unfit patients with for example ongoing hearth problems or stroke. Already in the ambulance the patient’s identification was established, blood samples were drawn and electrocardiography was taken. At admission to the hospital the ambulance personnel directly followed the patient to the x-ray unit and further to the orthopaedic ward without passing the acute and emergency unit.

Results: Patients included in the project felt that they were in safe hands and were satisfied with the handling time from the ambulance until they were at the ward. This time has diminished from 4 hours to half a hour. The mean time from admission to surgery was 29 hours for patients in the control group versus 21 hours for patients included in the project. Furthermore, the personnel at the x-ray unit are satisfied with the new organisation since there are more personnel lifting a better pain relieved patient from the trolley to the x-ray table.

Conclusion: When we are working in multi professional and multi functional teams with the LEAN concept, safety and quality of care can be improved if the preop-erative care of hip fracture patients is speeded up.


  • Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office{at}efort.org