Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Axel Ros, Jönköping University, Sweden
- Second opponent: Associate Professor Tina Strømdal Wik, St. Olavs Hospital, Norway
- Third member and chair of the evaluation committee: Professor II Sigbjørn Dimmen, University of Oslo
Chair of the Defence
Professor II Espen Haavardsholm, University of Oslo
Principal Supervisor
Professor II Wender Figved, University of Oslo
Summary
The main part of this Ph.D. thesis consists of quality improvement research centered around the treatment of hip fractures.
The goal of any medical quality improvement research is to change all the underlying processes of a treatment pathway to best practice and sustain the changes over time. It is paramount that a change in a process is founded in solid evidence from previous research. One needs to find and evaluate all the processes leading a patient through a treatment pathway, and then change them if not deemed to be according to current best practice. The new processes are then investigated for stability. The idea being that a stable process will yield a stable outcome.
We implemented a six-item improvement program in the treatment of hip fractures at our hospital and found both sustainability of the process changes and a 60 % reduction in both serious complications and reoperations after 7 years. We concluded that our improvement program led to a substantial and lasting improvement in the safety of our care process.
I then collaborated with the National Hip Fracture Registry examining one of the processes in our improvement research on a national level. After new national guidelines for prophylactic antibiotics were published in 2013 Norwegian hospitals slowly changed their practice. 2 years after the guidelines were introduced only 3 of 5 surgeries were performed with correct administration of antibiotics. I concluded that both hospital leaders and the national Directorate of Health needs to investigate better routines for dissemination of information thus yielding a faster process towards desired change.
Lastly, I studied periprosthetic fractures after hemiarthroplasty. There was not an increase in serious complications or death when compared to other complications following hemiarthroplasty. We however found that 1 in 3 patients needed a permanent higher level of care following their periprosthetic fracture thus underlining the seriousness of the condition.
Additional information
Contact the research support staff.