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Table 6 Proposed mechanisms and mediators for the effect of system factors on mortality

From: Patient and system factors of mortality after hip fracture: a scoping review

Factor Mechanism Mediator
Hospital volume Patients admitted to low volume hospitals are often delayed to surgery when compared to patients admitted to high volume hospitals [56]. Surgical delay
Nursing staff volume Higher nurse staffing may prevent or allow early detection of complications [28]. Complications
  Higher nurse staffing improves operating room availability and shorten time to surgery [28]. Surgical delay
Surgeon volume Low volume surgeons may not select appropriate procedure and preoperative planning, intraoperative technique and postoperative management [34]. Hypothesis only
Surgical delay Patients who are delayed to surgery are exposed to inflammatory and hypercoagulable states for longer than those who are not delayed [71, 72]. Hypothesis only
Hospitalization delay Patients may receive suboptimal care prior to admission and may develop pressure ulcers, thromboembolism, uncontrolled pain or delirium [50, 61]. Complications
Length of stay Institutionalized patients have shorter hospital stay than patients from community [36]. Discharge destination
Admission month Patients admitted in July may be exposed to lower staffing levels in holiday period [31]. Staffing volume