National Hip Fracture Database Reports on Developments in Acute and Post-Acute Care

Dr Helen Wilson, is co chair of the National Hip Fracture Database (NHFD), a joint endeavour of the BGS and the British Orthopaedic Association to improve the care of patients with fragility fractures.

Hip fracture, which usually results from the combination of a fall and pre existing osteoporosis, is the most common serious injury of older people, with around 76,000 cases occurring per year across the UK. Many patients are already frail. Mortality is high, residual disability common, and care costly. Although there is good evidence on best practice in surgical, medical and rehabilitation care following hip fracture, such care and its outcomes – in terms of return home and also of mortality – continue to vary.

The NHFD has published a supplement to its 2012 National Report which demonstrates continuing improvements in acute care but  highlights variations in post-acute care and overall length of NHS stay.

This supplementary report looks at case-mix adjusted mortality data from April 2011 to March 2012.  It has also, for the first time, reported on superspell data (the overall length of NHS stay).

It is extremely encouraging to see that routine Orthogeriatrician involvement in the peri-operative care of patients with hip has increased from 25% to 57% over the last four years mirrored by year on year reductions in 30 day mortality and improving secondary prevention.

However there is no room for complacency and we should be striving to continue to improve quality of care and to reduce mortality, ensuring robust systems are in place to do this.  Each unit should be reviewing mortality on a regular basis with case notes review in clinical governance meetings attended by all members of the hip fracture programme.  Those trusts whose mortality falls outside the funnel plot have been offered detailed peer review of their services to aid improvement.

Superspell data looks at total time spent in NHS in-patient care and has been calculated using HES data to capture both the acute (in A&E and orthopaedic wards), post-acute (transfer to another specialty in the same Trust) and total NHS in-patient stay which also includes time in PCT rehabilitation units.  It is acknowledged that data may not be complete for the latter and that superspell does not include other NHS funded services such as early supported discharge schemes at home.  There is wide variation across the country with average total length of stay in NHS in-patient care ranging from 12.4 to 44.5 days with a mean of 26 days.

Further work needs to be done in this area to understand the variations and to work towards ensuring all patients have access to good quality post-acute care and appropriate early supported discharge as outlined by the NICE quality standards for hip fracture with the overall aim of returning as many patients as possible to their pre-morbid level of functioning and reducing institutionalisation.

1 thought on “National Hip Fracture Database Reports on Developments in Acute and Post-Acute Care

  1. As a trainee pre- and post the introduction of the hip fracture tariff and database, there is no doubt that care of older patients with hip fractures has improved by the regular and routine involvement of Ortho-geriatricians. I worked as an orthopaedic SHO where I was the only person who would be looking after post-operative older patients with hip fractures and dealing with their medical problems. We hardly looked at the CXR or ECG or even screened for osteoporosis or did an AMTS. Ortho-geriatrics has certainly come a long way in a relatively short space of time [ as i am still in training].

    Hospitals have evolved their service to prioritize meeting the requirements of the hip fracture tariff. One of the shortfalls of this (and perhaps of the hip fracture database) is what happens to older patients who do not have hip fractures but other types of fractures [ankle, femur, knee)? How do they do in comparison? Anecdotally, it is my experience that Ortho-geriatricians mainly concentrate on the hip fracture patients and others if requested or on an ad-hoc basis. Also, there are a variety of models of orthogeriatric care [ from routine daily visits to the orthopaedic ward to Orthogeriatricians being principal consultants of the hip fracture patients with visits by orthodopaedic surgeons instead] it is not clear which model delivers the best results. Again, the database might be best positioned to address this issue,

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