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Re: Waiting Times For Hip Fractures

We read with interest the study by Chia et al1 showing that delays in x-rays results in delay in admission for patients with hip fractures. They report that a patient with a hip fracture is regarded as ‘non-urgent’ and as a result may have to wait for treatment. As this study is based in Taiwan they may not be aware of the ‘fast-track’ scheme and guidelines from the UK Audit Commission recommending that patients wait no longer than 1hour in A&E.2 As a result most patients with a possible hip fracture are not seen as ‘non-urgent’ on presentation. They emphasise the critical role that early surgery plays in the outcome of these patients but seem to blame this on delays in A&E. It is indeed true that long waits on trolleys in A&E are uncomfortable, inconvenient, predispose to pressure sores, and delay surgical intervention. However studies have shown that despite fast-tracking patients in A&E, some 55% of patients still wait over 24hrs for their operation.3 As Chia et al report that only 25% of patients waited more than 10minutes from arrival to X-ray I feel that the ‘delay’ in x-ray is not really applicable to the UK. Indeed the maximum time for both groups in their study fell within the national 1hr target. In conclusion, we agree with the authors that waiting times for patients with hip fractures is important and may need improvement, but feel that the solution offered is only addressing a minor issue. We feel that addressing the delay after admission to the ward would reap greater rewards.