SRS182 - Pre-operative haemoglobin (Hb) monitoring in neck of femur (NOF) fracture patients at a major trauma centre

Abstract Introduction Timely pre-operative haemoglobin (Hb) checks are essential in managing neck of femur (NOF) fracture patients, given risk of anaemia and surgical delay. Local guidelines recommend daily Hb monitoring while awaiting theatre and on postoperative days 1 and 2. This audit assessed compliance with the standard that all NOF patients should have an Hb check (via Hemocue, venous blood gas [VBG], or full blood count [FBC]) on the day of surgery. Methods A retrospective audit of NOF admissions over two months (July–August 2024) was performed using electronic patient records. Interventions included staff education, introduction of a second night senior house officer (SHO), and improved Hemocue access. A re-audit was undertaken in December 2024 using the same methodology. Results Initial audit (n = 118) showed 28% compliance. Mean delay to theatre was 2.06 days; mean pre-operative Hb drop was 9 g/L (range 0–43), with 19% having Hb <100 g/L. Re-audit (n = 53) demonstrated 70% compliance, mean delay reduced to 1.67 days, mean Hb drop was 8 g/L (range 0–42), with 21% having Hb <100 g/L. Improvement in day-of-surgery Hb checks was statistically significant (χ²(1, N = 168) = 28.2, P < 0.05), as was the reduction in time to theatre (t(168) = 2.18, P = 0.03). Barriers included faulty Hemocue devices and misunderstanding of repeat Hb check requirements. Conclusions Targeted interventions significantly improved Hb monitoring compliance and reduced surgical delays. Ongoing education, reliable Hemocue availability, and proactive SHO involvement are essential for sustaining compliance and optimising outcomes.