Standardising Bone Health Discharge Communication After Hip Fracture: A Quality Improvement Project

Introduction:
Macclesfield Hospital has a busy trauma ward where the orthogeriatrics team primarily manages patients admitted with fractured neck of femur. We identified inconsistent communication of bone health management plans to community and rheumatology teams at discharge, particularly regarding zoledronic acid infusion dates and follow-up arrangements which posed a risk to continuity of care. A baseline audit reviewed three months of discharge summaries for patients aged over 65 admitted with fractured neck of femur, assessing documentation of FRAX score, vitamin D status, zoledronic acid infusion date, and follow-up plan.

Methods:
A quality improvement project using Plan–Do–Study–Act (PDSA) methodology was undertaken. A driver diagram informed intervention design, leading to the development of a standardised bone health discharge proforma to support documentation standards. The proforma was implemented within the orthogeriatrics team. Discharge summaries were re-audited over a two-month period using the same criteria in the introduction. Data was displayed using run charts. The proforma has since been embedded into routine discharge summary creation, with future plans to involve the orthopaedic team.

Results:
Following implementation, documentation improved across all domains. The total number of patients included before intervention was 36, and post intervention 16. Monthly average documentation of FRAX score increased from 15.6% to 48.2%, vitamin D status from 59.7% to 95.5%, zoledronic acid infusion dates from 64.5% to 90%, and follow-up plans from 60.3% to 100%.

Conclusions:
This project improved the quality and consistency of discharge summaries for patients with fractured neck of femur, supporting transition of care into the community. Limitations included reliance on manual copying of the proforma into electronic discharge summaries and staff awareness, leading to occasional omissions. Future work will focus on electronic integration into the digital clinical system, and wider engagement with the orthopaedic resident doctors to achieve sustained improvement.