Abstract
Hip fractures tend to affect older, frailer people and are associated with high morbidity and mortality. The Best Practice Tariff (B PT) was introduced to recognise gold standard care. Features of the BPT include prompt surgical and orthogeriatric input, with multidisciplinary working throughout. Subsequent service changes have led to the creation of specialist hip fracture wards. However, it is not always possible to admit patients with a fractured neck of femur to a specialist hip fracture ward.
We reviewed data for 691 patients admitted with a primary neck of femur fracture to a district general hospital in Sussex between 01/02/2023 and 29/02/2024. We compared the demographics and outcomes of patients admitted to a specialist hip fracture ward (SHFW) and a general surgical ward (GSW) using data available from the National Hip Fracture Database. 570 patients were admitted to the SHFW, 121 to the GSW.
BPT achievement was significantly higher on the SHFW (74% SHFW, 53% GSW, p<0.00001). 30-day mortality was lower on the SHFW, although this was not statistically significant (2.98% SHFW, 5.79% GSW, p=0.126). We found no significant difference in patient age, time to surgery, time to orthogeriatrician review, or length of stay.
This analysis highlights the importance of a specialist multidisciplinary team approach in the management of patients presenting with fractured neck of femur. While not a perfect metric, non-achievement of the BPT is likely to result in worse patient care, with higher mortality and poorer longer term functional outcomes. BPT non-achievement is also associated with significant loss of income to NHS trusts. We suggest that, wherever possible, beds on specialist hip fracture wards should be ring fenced for patients with primary neck of femur fracture.