Impact of Care Delivered in Nondesignated Areas on Older Patients Admitted With Hip Fractures: A Quality Improvement Initiative

ABSTRACT Background Although testimonies of devastating impacts of care delivered in nondesignated hospital areas (corridor care) are mounting, there is a paucity of quantitative data. This study aimed to assess the associations between: (1) care in nondesignated areas and key performance indicators (KPIs), including ward moves and length of stay (LOS); and (2) between KPIs and mortality. Methods Data from this cross‐sectional study were derived from the National Hip Fracture Database audit programme (a quality‐improvement initiative commissioned by the Healthcare Quality Improvement Partnership, NHS England). In total, 508 patients (65% women) consecutively admitted with hip fractures (January 2024–January 2025) were included. The duration (h:min) of care in nondesignated areas was categorised by tertiles (< 1:20; 1:20–4:20; > 4:20). Associations between variables were determined by logistic regression, presented as odds ratios (OR) and 95% confidence intervals. Results Patients cared for in nondesignated areas (11%) and bed care patients (89%) had similar clinical characteristics (median age = 85.5 years). Care in nondesignated areas varied inversely with seasonal average local temperatures: 10.7% in summer (22.5°C), 19.6% autumn (15.9°C), 44.6% winter (8.6°C), and 25.0% spring (14.9°C), which was more discernible than the corresponding distribution of bed care: 21.2%, 23.7%, 25.9% and 29.2%. Compared with bed care patients, those cared for in nondesignated areas for ≥ 1 h:20 min were associated with ≥ 3 ward moves: OR = 4.02 (1.61–10.06). LOS on orthogeriatric wards for bed care patients was 13.4 days, and care in nondesignated areas > 4 h:20 min was 17.2 days, which increased to 19.7 days for all patients cared for in nondesignated areas with ≥ 3 ward moves. In turn, higher in‐hospital mortality was associated with multiple ward moves: OR = 2.63 (1.23–5.66) and prolonged LOS: OR = 3.23 (1.53–6.81). Conclusions The impact of care delivered in nondesignated areas exposed by KPIs is consistent with testimonies from patients and NHS staff. This evidence serves as a stimulus to take urgent action to abolish care in nondesignated areas.