NHFD report reveals quality of service of hip fracture patients
The sixth National Hip Fracture Database (NHFD) report has revealed that over 64,000 hip fracture injuries take place each year. This leads to the occupation of over 4000 inpatient beds at any one time across England, Wales and Northern Ireland, which equates to one in 40 of all NHS beds.
Hip fracture is an ideal marker of the quality of care given to frail and older patients in the NHS. The NHFD report aims to improve efficiency of care after hip fracture, to prevent second fracture and, overall, to improve early intervention.
The NHFD report details variation in practice around the UK, supporting the development of the best way to care for the frail and older patients who experience hip fracture injuries.
This latest NHFD report reveals a national improvement across all standards when directly compared with last year’s report. The report’s main findings include:
- More patients (72.1 per cent) now receive surgery on their first or second day in hospital but there remains unacceptable variation; different units reported figures ranging from 14.7 per cent to 95.3 per cent.
- More patients are now offered total hip replacement but this was still only performed in 20.6 per cent of the 15,685 patients who met the clinical criteria for this procedure.
- Three-quarters (73.3 per cent) of patients were mobilised from bed on the day after surgery but 21 hospitals (11.7 per cent) achieved this in fewer than half of cases.
- More patients (85.3 per cent) received orthogeriatric assessment in the peri-operative period but seven units (4 per cent) reported that they still had no orthogeriatric service.
- Hip fracture teams may lack influence over post-acute rehabilitation and only six (3 per cent) hospitals reported that their local community rehabilitation team was represented at their monthly hip fracture programme clinical governance meetings.
The report’s key recommendations include:
- Staff in hip fracture programmes should consider the purpose of monthly clinical governance meetings that are central to improving care in individual units.
- Hospital managers should challenge areas that require improvement, such as the variation in rates of prompt surgery.
- Commissioners should use this report to understand the performance of hospitals from which they are commissioning services, for example, how well integrated hospital and community health services work.
Rob Wakeman, NHFD clinical lead, orthopaedic surgery, said: “Hip fracture is a major cause of death and disability in older people who fall. Our results show a gradual overall improvement in the quality of care offered, but some hospitals have a deteriorating service, while others have failed to make significant progress. From the recommendations of the report, I encourage local hospitals and their commissioners to find ways to improve these services”.
Source: Anaesthesia UK