NHFD national report shows care for hip fracture patients is improving

18 September 2013

The National Hip Fracture Database is a joint venture of the British Geriatrics Society and the British Orthopaedic Association, and is designed to facilitate improvements in the quality and cost effectiveness of hip fracture care.  Follow it on Twitter @NatHipFracData NHFD2

Hip fracture is a common, serious and costly injury affecting mainly older people. It usually results from the combination of osteoporosis and a fall from standing height or less.  Care is complex and involves surgical, medical and rehabilitation interventions.

The National Hip Fracture Database 2013 report covers casemix, care and outcomes of 61,508 cases submitted between 1 April 2012 and 31 March 2013 by 180 hospitals in England, Northern Ireland and Wales.

Care is audited against six standards set out in the BGS/BOA publication The care of patients with fragility fracture (The Blue Book); and comparison with the same six standards from the 2012 National Report shows that this year:

  • 50% of patients are admitted to an orthopaedic ward within four hours (down from 52% in 2012)
  • 86% receive surgery within 48 hours (improved from 83%)
  • 3.5% are reported as having developed pressure ulcers (improved from 3.7%)
  • 49% are reported as assessed pre-operatively by an orthogeriatrician (up from 43%)
  • 69% are discharged on bone protection medication (unchanged)
  • 94% received a falls assessment prior to discharge (up from 92%)

Our results are set alongside data from national data sources to allow a more comprehensive picture of total length of stay and mortality.

Casemix adjusted reporting on two key measures (30 day mortality, and return to own home by 30 days) is used to compare different hospitals’ outcomes. These outcomes are drawn against the mean and standard deviation according to the size of the unit and in the case of 30-day mortality, protocols have been developed to check the quality of data for outlying hospitals, and to feedback information that might help them in reviewing their clinical service.

To test the robustness of this year’s analysis we used data collected over the past three years (2010–13) to examine trends in performance for the outliers identified in this year’s report.

NHFD1 The overall rate of mortality at 30 days in this larger dataset is 8.4%.

Next year we plan to move to making this three year slice of data central to reporting outcome. This will improve our sensitivity to poor performance.

With more than 250,000 cases now documented, the NHFD is the biggest audit of its kind in the world, and its success has led to its work being replicated in Ireland, which now has an Irish Hip Fracture Database, with similar developments in hand in Australia and New Zealand, Canada, and Hong Kong.

Download a full copy of the report at www.nhfd.co.uk

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