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Trial registered on ANZCTR
Registration number
ACTRN12619000296134
Ethics application status
Approved
Date submitted
18/02/2019
Date registered
26/02/2019
Date last updated
26/02/2019
Date data sharing statement initially provided
26/02/2019
Date results information initially provided
26/02/2019
Type of registration
Retrospectively registered
Titles & IDs
Public title
Reducing the risk of post-operative delirium in elderly hip fracture surgical patients by implementing a multidisciplinary approach to analgesia, education, and medications
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Scientific title
Delirium reduction after hip fracture surgery through a multidisciplinary care bundle
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Secondary ID [1]
297434
0
Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
delirium
311609
0
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hip fracture
311610
0
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Condition category
Condition code
Neurological
310235
310235
0
0
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Other neurological disorders
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Surgery
310236
310236
0
0
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Other surgery
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Injuries and Accidents
310326
310326
0
0
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Fractures
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Multidisciplinary care bundle including:
1. Ward and staff education on causes and risks of delirium. Education on national guidelines for clinical management of post-operative delirium
Particulars include:
- oral powerpoint presentations at fortnightly department training sessions over study period (prospective recruitment of 150 patients managed under care bundle), designed specific for this study
- hardcopy handouts of national guidelines during sessions
- laminated cognitive aids describing protocol placed on noticeboards, designed specific for this study
- all delivered by researchers
2. Initial fascia iliaca block for analgesia when presented to the emergency department
set protocol of 30ml of 0.2% plain ropivacaine, single dose, via ultrasound-guidance, prior to discharge to ward
3. Second fascia iliaca block to continue analgesia when presenting for hip fracture surgery
set protocol of 30ml of 0.2% plain ropivacaine, single dose, via ultrasound-guidance, prior to surgical incision
4. Rationalisation of medications to reduce polypharmacy and known drug triggers for post-operative delirium by emergency physicians, anaesthestists, orthogeriatricians, and ward medical staff
5. compliance to above audited weekly by researchers. Compliance rates published fortnightly as educational newsletters sent electonically to all clinical staff, and as hardcopy on department notice boards.
Compliance data compiled by manual search through hardcopy medical record of each patient, as well as electronic clinical notes, and of medication charts
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Intervention code [1]
313686
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Behaviour
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Intervention code [2]
313688
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Treatment: Drugs
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Comparator / control treatment
150 hip fracture patients admitted to Liverpool Hospital prior to start of intervention, who received standard care, in 2017
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Control group
Historical
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Outcomes
Primary outcome [1]
319132
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new onset post-operative delirium, using the Confusion Assessment Method. Researchers will directly screen all patients on the ward
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Assessment method [1]
319132
0
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Timepoint [1]
319132
0
Day 3 post-operative
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Secondary outcome [1]
367065
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mortality, as checked by researchers using medical records, and phone call to general practitioner or next of kin
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Assessment method [1]
367065
0
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Timepoint [1]
367065
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Day 30 post-operative
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Secondary outcome [2]
367066
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composite secondary outcome of major morbidity, cardiac ischaemia, congestive cardiac failure, cardiac arrest, stroke, pulmonary embolus, acute kidney injury. Researchers will perform manual screen of medical records, biochemistry results, pathology and radiology results, and a phone call to the patient's general practitioner or next of kin
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Assessment method [2]
367066
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Timepoint [2]
367066
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Day 30 post-operative
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Secondary outcome [3]
367067
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residential status, through manual phone call to patient's general practitioner or next of kin
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Assessment method [3]
367067
0
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Timepoint [3]
367067
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Day 30 post-operative
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Secondary outcome [4]
367068
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walking ability assessed through phone call to general practitioner, or next of kin
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Assessment method [4]
367068
0
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Timepoint [4]
367068
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Day 30 post-operative
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Eligibility
Key inclusion criteria
emergency surgery
isolated single hip fracture, defined as between femoral head and 5cm below the lesser trochanter
age greater than 50 years old
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Minimum age
50
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
elective admission
multiple fractures
age less than 50 years old
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
not concealed
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Other
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Other design features
before-and-after trial design
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Phase
Phase 4
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
primary outcome is categorical, chi-square test to be used
secondary outcomes are categorical, chi-square test to be used
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
1/06/2017
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Date of last participant enrolment
Anticipated
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Actual
1/11/2018
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Date of last data collection
Anticipated
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Actual
7/12/2018
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Sample size
Target
300
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Accrual to date
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Final
300
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
13179
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Liverpool Hospital - Liverpool
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Recruitment postcode(s) [1]
25734
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2170 - Liverpool
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Funding & Sponsors
Funding source category [1]
302003
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Hospital
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Name [1]
302003
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Department of Anaesthesia, Liverpool Hospital
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Address [1]
302003
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Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
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Country [1]
302003
0
Australia
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Primary sponsor type
Individual
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Name
A/Prof Alwin Chuan
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Address
Department of Anaesthesia
Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
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Country
Australia
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Secondary sponsor category [1]
301787
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None
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Name [1]
301787
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Address [1]
301787
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Country [1]
301787
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
302679
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South western Sydney LHD HREC
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Ethics committee address [1]
302679
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Locked Bag 7103
LIVERPOOL BC,
NSW, 1871
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Ethics committee country [1]
302679
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Australia
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Date submitted for ethics approval [1]
302679
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01/03/2017
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Approval date [1]
302679
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28/05/2017
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Ethics approval number [1]
302679
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HREC/17/LPOOL/19
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Summary
Brief summary
Delirium is a common complication of patients admitted for hip fracture surgery, and is associated with increased risk of mortality, morbidity, and loss of functional independence, as well as high social, nursing and health care costs. National guidelines describe care plans and delirium reduction strategies, but inadequate education and lack of coordinated clinical management results in large variations in quality of care in Australian and New Zealand hospitals.
This study will investigate if a multidisciplinary care bundle, which includes evidence based clinical interventions and regular educational initiatives reduces the risk of delirium in hip fracture patients classified as intermediate or high risk by 40%.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
91038
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A/Prof Alwin Chuan
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Address
91038
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Department of Anaesthesia
Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
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Country
91038
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Australia
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Phone
91038
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+61 2 8738 3173
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Fax
91038
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Email
91038
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[email protected]
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Contact person for public queries
Name
91039
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A/Prof Alwin Chuan
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Address
91039
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Department of Anaesthesia
Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
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Country
91039
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Australia
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Phone
91039
0
+61 2 8738 3173
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Fax
91039
0
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Email
91039
0
[email protected]
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Contact person for scientific queries
Name
91040
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A/Prof Alwin Chuan
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Address
91040
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Department of Anaesthesia
Level 1, New Clinical Building
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
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Country
91040
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Australia
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Phone
91040
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+61 2 8738 3173
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Fax
91040
0
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Email
91040
0
[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
No approval from ethics committee
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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