The first national clinical audit to investigate the care received by patients who have fallen and fractured bones (hip, wrist, arm, pelvis or spine) shows that an inadequate service is being provided by most local health services, and that there are unacceptable variations of care across PCTs and Trusts in England, Northern Ireland and Wales.
Figures from 157 Trusts showed that 80% of people with hip fractures spent over two hours in A&E before transfer to a suitable ward, in contrast to accepted best practice. In addition, less than a third had a pre-operative medical review by a suitably trained physician, despite the high rates of co-morbidity in this patient group. Of particular concern was the fact that 31% of operations for hip fracture were delayed beyond the 48 hours target, when it is known that this is associated with increased mortality.
Furthermore, most patients returning home from A&E after a fragility fracture were not offered a falls risk assessment and only 22% were referred for exercise training to reduce future falls. Three months after sustaining the fracture, only a fifth of these patients were on appropriate treatment for osteoporosis.
