Improving Documentation of Core Orthogeriatric Assessments for Hip Fracture Patients

Background: The National Hip Fracture Database (NHFD) and Best Practice Tariff emphasise timely bone health assessment, cognitive screening, and geriatric review for patients with hip fracture. In practice, these assessments may be completed but not clearly documented, risking missed postoperative delirium, suboptimal secondary fracture prevention, and limiting multidisciplinary communication.

Aim: To increase the proportion of orthogeriatric hip fracture patients on the ward with documented bone health assessment, cognitive assessment, and geriatric assessment within 72 hours of admission.

Methods: Three consecutive PDSA cycles were undertaken, each including 20 orthogeriatric hip fracture admissions. For each patient, documentation of bone health assessment, cognitive assessment/4AT, geriatric assessment within 72 hours, and completion of all three domains was recorded. PDSA1 introduced structured verbal reminders during ward and board rounds. PDSA2 added visual prompts at ward workstations, using a checklist summarising the three key assessments.

Results: At baseline, 70% of patients had bone health assessment documented within 72 hours, 90% had cognitive/4AT documented, and 100% had geriatric assessment within 72 hours; 55% had all three domains documented. Following verbal reminders, these figures improved to 90%, 85%, and 100%, respectively, with 65% having all three domains documented. Following visual prompts, bone health assessment remained at 80%, cognitive/4AT documentation increased to 95%, and geriatric review stayed at 100%, with 75% having all three domains documented. Pre-operative 4AT completion remained at 90% across cycles, but post-operative 4AT documentation fell from 100% at baseline to 95% and then 60%.

Conclusion: Simple, low-cost interventions such as verbal reminders and visual prompts improved documentation of key orthogeriatric assessments. However, declining post-operative 4AT documentation highlights the need for further system-level changes, including embedding pre- and post-operative 4AT prompts into clerking and postoperative review proformas.