Improvements in hip fracture care are being driven by national clinical audit, strong support networks and extra payments for hospitals, a report finds.
The National Hip Fracture Database 2011 Report shows significant improvements in the quality of care for the 70,000 patients who sustain the injury each year.
At a time when care of the elderly is giving concern, doctors say the approach on hip fractures provides a practical and achievable model that should now be followed more widely.
The report covers more than 53,000 cases admitted between April 2010 and March 2011, and shows consistent improvements in compliance with the six clinical standards measured.
Since the audit began in 2007 more patients are being admitted promptly to orthopaedic wards; delays for operation have been reduced, with the great majority of patients now having surgery within 48 hours.
Fewer patients develop pressure ulcers; and more have specialist pre-operative assessment by a care of elderly physician. Prevention of future fractures is being addressed too: 71% of patients will receive both falls and bone health assessments before leaving hospital.
In 2009, only 12,983 cases met the standards, compared with 53,433 cases in 2011.
There is still room for improvement with significant variation persisting across the country. Two per cent of medically fit patients still wait more than four days for surgery which has serious implications for their recovery and survival. Furthermore, detailed case mix-adjusted statistical analysis of 30-day mortality reveals that a few hospitals have mortality rates that require detailed attention and further analysis.
Dr Colin Currie, consultant geriatrician and chair of the NHFD implementation group, said: “This report shows how a national audit addressing the care of a serious common injury can make a difference on a national scale. The combination of reliable data, achievable standards, continuous feedback, and available know-how has attracted widespread clinical and managerial support, with real gains in both the quality and cost-effectiveness of hip fracture care.
“Clinical teams can look at their own data, spot problems, work together, make changes, and see measurable benefits resulting for the patients they look after.”
The collaborative leadership between the British Geriatrics Society and the British Orthopaedic Association that created the NHFD has driven positive change at the clinical “sharp end”.
Local multidisciplinary teams have been encouraged to deliver continuous improvement in care, particularly through the advent of innovative NHS funding models designed to incentivise ‘best practice’. These models actively support local management in focusing resources to develop high quality services, and the report suggests this model has potential for wider adoption across the NHS.
Mr Peter Kay, president of the British Orthopaedic Association, said: “The importance of this report cannot be over-stated. Not only does it demonstrate how we can improve the care of some of our frailest and most vulnerable patients, but it also highlights the enormous benefit of aligning NHS funding, as a driver of change, with best clinical practice.”
From March 2012 the audit is set to merge with the Royal College of Physicians’ falls audit and cover other forms of fracture suffered by elderly patients in a re-titled “Falls & Fragility Fractures Audit”.
Read the full report.
