The latest national hip fracture audit has revealed that NHS hip fracture patients are now getting far greater access to specialist care by geriatricians, as well as osteoporosis screening, assessment for the likelihood of future falls, and bone protection drugs.
However, the report also flags up significant variations in care quality provision between hospitals, with some patients not being assessed by appropriate doctors, having unacceptable delays before surgery, and missing out on osteoporosis care and falls prevention. The National Hip Fracture Database National Report 2010 covers more than 36,000 hip fracture patients treated in hospitals in England, Wales, Northern Ireland and the Channel Islands. A collaboration between the British Orthopaedic Association and the British Geriatrics Society, the audit is funded by the Healthcare Quality Improvement Partnership (HQIP).
Key findings of the 2010 report include:
• 68% of patients were assessed for bone protection medicine, while 57% were discharged on this treatment. A further 7% were awaiting a bone scan or bone clinic appointment – bringing the total to 75% (up 15% from 2009).
• 60% of patients now receive an assessment to determine the likelihood of future falls, with 3% awaiting appointments. The total has increased to 63% (up 19% from 2009).
• 31% were assessed pre-operatively by a geriatrician, with 32% having other forms of medical assessment, bringing the total to 63% (up 22% from 2009).
• 80% of patients receive surgery within 48 hours (up 5% from 2009).
• 57% of patients are admitted to an orthopaedic ward within four hours.
The 2010 report also provides examples of how individual hospitals have improved the care they provide. For example, the Royal Surrey Hospital introduced joint orthogeriatrician and surgical care, with the implementation of additional trauma lists, daily orthogeriatrician ward rounds, an integrated care pathway and a patient care handbook. Length of stay was reduced by six days, and mortality by 3%. £220,000 implementation costs were offset by £450,000 savings in bed days. In Basildon, improved medical care following the introduction of daily orthogeriatrician ward rounds resulted in a sustained fall in mortality – which had been high. The percentage of patients dying within 30 days of fracture is now only 4.9% compared with the national average of 7.7% In response to the National Hip Fracture Database National Report 2010, Michelle Mitchell, charity director at Age UK, commented: “Falls represent the most frequent and serious type of accident in the over 65s. So it is very worrying that following a hip fracture, nearly one third of people are not being given the appropriate medication, care and support to reduce the risk of falling and injuring themselves again.”
