Informing future resilience of UK healthcare: a mixed methods study of hip fracture care during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic stressed healthcare systems globally. Despite urgent pressure to provide care for people with COVID-19, healthcare continued to be needed for other conditions. Studies describing how such care was adapted provides vital information for future, resilient healthcare planning. With 80,000 people sustaining a hip fracture each year in the UK, maintenance of multidisciplinary healthcare for hip fracture during the pandemic was essential. We aimed to examine how hospital services and multidisciplinary teams delivered complex hip fracture care to inform future design of resilient services. Methods Resilience can be explored at individual (micro), organisational (meso), and national/regional health system (macro) levels. This study focused on meso-level resilience. A convergent mixed-methods design was used, integrating quantitative and qualitative findings. In 2020 the National Hip Fracture Database (NHFD) surveyed the pandemic response of 164 UK hospitals. Findings were mapped onto 16 in-depth qualitative interviews conducted in 2021 at four diverse hospitals with healthcare professionals. Results During the first UK wave of COVID-19, 17% of hospitals diverted all or part of their hip fracture intake to another hospital, but most (83%) still accepted all presenting patients. The pandemic affected the organisation of care through delayed surgery, reduced orthogeriatrician availability, disrupted communication and placement of patients on wards without specialist expertise. We identified key strategies used by services to adapt: (1) reallocation of material and human resources, including changes to elective surgery and staffing, (2) trade-offs and workarounds, including making clinical decisions without information about COVID-19 status, (3) reorientation of organisational goals to facilitate expedited discharge, (4) reconfiguration of physical spaces such as wards, (5) staff upskilling and in-situ training, (6) leadership and collaboration, including enabling staff to adapt care pathways, and (7) information transfer processes using new technologies. Conclusions The seven strategies provide a framework for resilient multidisciplinary meso-level hip fracture care. Strategies can be used to refine healthcare services, complemented by audit and evaluation to understand impacts on healthcare utilisation, costs and patient outcomes.