Better care of hip fracture patients saves money as well as being ethically desirable, shows a huge audit of NHS care of people with hip fracture. It found that there has been great improvement overall since 2007. But it also reveals significant variations between hospitals in different regions, in terms of the time to surgery, lack of appropriate assessment, and failure to assess and respond to patients’ osteoporosis and risk of future falls.
More than 36,000 people in England, Wales, Northern Ireland and the Channel Islands who were treated for hip fracture were included in the National Hip Fracture Database (NHFD) National Report 2010, which is the biggest such audit in the world. The report, for the British Orthopaedic Association and the British Geriatrics Society, was funded by the Healthcare Quality Improvement Partnership.
The report’s authors applaud the 22% rise since last year in the proportion of patients who have a geriatrician or other medical assessment, to 63% this year. And 60% are now assessed regarding their likelihood of suffering further falls in the future.
More than half (57%) of patients were admitted to an orthopaedic ward within 4 hours, and 80% had surgery within the recommended 48 hours. The audit also showed an enormous rise in the percentage of fragility fracture patients who are assessed for and given bone protection medicines, from just 15% in 2007 to 57% in 2010, with a further 7% of patients still awaiting their bone scan or bone clinic appointment.
The 2010 Report gives examples of cases in which clinicians and managers collaborated to improve their care of patients with fragility fractures:
- The Royal Surrey Hospital introduced joint orthogeriatrician and surgical care, with the implementation of additional trauma lists, daily orthogeriatrician ward rounds, an integrated care pathway and a patient care handbook. Average stay was reduced by 6 days, and mortality by 3%. The high implementation cost of £220,000 was offset by £450,000 savings in bed days.
- In South Tees, a multidisciplinary project reduced delay in A&E, raised the percentage of patients having surgery within 48 hrs from 62% to 81%, and lowered average length of acute hospital stay from 18 to 12.6 days.
- In Mayday University Hospital, in Croydon, a trauma group improved the hip fracture care pathway, and reduced average time to surgery from 58.8 hours to 28.9, with 87% of patients waiting less than 48 hours, and average acute stay falling from 32.6 to 22 days.
Rob Wakeman, NHFD’s lead clinician in orthopaedic surgery and a consultant orthopaedic surgeon in Basildon, said: “Big improvements in the quality of hip fracture care can be achieved in a short space of time. It is vital that those few units that are still under-performing use this guidance and the examples of best practice to improve services in line with the rest of the UK.”
Colin Currie, NHFD’s lead clinician in geriatric medicine and a consultant geriatrician in Edinburgh, said: “Cost and quality of care are not in conflict because looking after hip fracture patients well is far cheaper than looking after them badly. So there is now absolutely no excuse for the sub-standard care that we are still seeing in some hospitals.”