The sixth National Hip Fracture Database (NHFD) report reveals that over 64,000 hip fracture injuries take place each year. This leads to the occupation of over 4,000 inpatient beds at any one time across England, Wales and Northern Ireland, which equates to 1 in 40 of all NHS beds.
The latest NHFD report shows that 64,102 patients were admitted to hospital with a hip fracture between 1 January and 31 December 2014. Hip fracture is an ideal marker of the quality of care given to frail and older patients in the NHS. This latest NHFD report reveals a national improvement across all standards when directly compared with last year’s report. The report’s main findings include:
- More patients (72.1%) now receive surgery on their first or second day in hospital but there remains unacceptable variation; different units reported figures ranging from 14.7% to 95.3%.
- More patients are now offered total hip replacement but this was still only performed in 20.6% of the 15,685 patients who met the clinical criteria for this procedure.
- Three-quarters (73.3%) of patients were mobilised from bed on the day after surgery but 21 hospitals (11.7%) achieved this in fewer than half of cases.
- More patients (85.3%) received orthogeriatric assessment in the peri-operative period but seven units (4%) reported that they still had no orthogeriatric service.
- Hip fracture teams may lack influence over post-acute rehabilitation and only six (3%) hospitals reported that their local community rehabilitation team was represented at their monthly hip fracture programme clinical governance meetings.
The report’s key recommendations include:
- Staff in hip fracture programmes should consider the purpose of monthly clinical governance meetings that are central to improving care in individual units.
- Hospital managers should challenge areas that require improvement, such as the variation in rates of prompt surgery.
- Commissioners should use this report to understand the performance of hospitals from which they are commissioning services, for example, how well integrated hospital and community health services work.
Mr Rob Wakeman, NHFD clinical lead, orthopaedic surgery, said: “Hip fracture is a major cause of death and disability in older people who fall. Our results show a gradual overall improvement in the quality of care offered, but some hospitals have a deteriorating service, while others have failed to make significant progress. From the recommendations of the report, I encourage local hospitals and their commissioners to find ways to improve these services.”
The NHFD audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit (NCA) Programme. The NHFD audit is managed by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians (RCP) as part of the Falls and Fragility Fracture Audit Programme (FFFAP).
