18 September 2013

It is estimated that there are 70,000 hip fractures a year in the UK[1] and this is only set to increase as the population gets older. The latest National Hip Fracture Database (NHFD) report, from the British Orthopaedic Association (BOA), the British Geriatrics Society (BGS) and the RCP, finds that care for patients with hip fracture is improving. More patients are receiving surgery within 48 hours of admission than in 2012 and almost all patients (94%) are receiving a falls assessment before being discharged from hospital.

The National Hip Fracture Database national report 2013, commissioned by the Healthcare Quality Improvement Partnership (HQIP), details that the quality of care patients receive and the timeliness in which they undergo surgery for hip fracture are getting better. It also indicates that, at any one time, over 4,000 NHS beds in England, Wales and Northern Ireland are occupied by a patient recovering from hip fracture. The report, published today, shows that:

  • 86% of patients receive surgery within 48 hours
  • 3.5% of patients are reported to have developed pressure ulcers
  • 49% of patients are being assessed by an orthogeriatrician
  • 94% receive a falls assessment prior to discharge.

The number of patients being admitted to an orthopaedic ward within 4 hours is down slightly from 52% in 2012 to 50% in 2013.

The 2013 NHFD report sees the largest number of data records submitted, from the largest number of hospitals and the largest number of patients since the NHFD first began in 2007. This national report profiles the care of over 95% of all cases; 61,508 cases from 180 hospitals.

In spite of the progressive improvements that the NHFD has documented in this and previous reports, there remains considerable variation in the care being offered in different hospitals. The report describes this in detail, and examines the potential implications of this variation by comparing mortality figures in different hospitals. A number of hospitals with poorer figures are identified and will be offered support in addressing persistent problems.

There is also considerable variation in the length of time that patients spend in hospital recovering from hip fracture. The report highlights that hospitals in England are achieving reduced length of stay with an average of 22 days for hip fracture patients, compared with hospitals in Wales (35 days) and Northern Ireland (33 days).

The NHFD is a collaboration between the BOA and the BGS and is managed by the RCP and commissioned by HQIP. It aims to improve the quality and effectiveness of hip fracture care by enabling clinical teams to monitor their performance against agreed clinical standards from the BOA and BGS. The NHFD also monitors compliance with the NICE Guidance 124 - ‘The Management of Hip Fracture in Adults’.

Dr Kevin Stewart, clinical director, Clinical Effectiveness and Evaluation Unit (CEEU), RCP said:

The results from the latest NHFD national report are very encouraging, demonstrating that the quality of care for hip fracture patients continues to improve.  Since hip fracture mainly affects frail older patients, it is especially important that we get it right in this vulnerable population. These results have been achieved despite the recent well-publicised pressure on emergency departments. They are a tribute to the national leadership of the British Orthopaedic Association and the British Geriatrics Society and the dedication of the national leadership team and multidisciplinary clinical teams up and down the country.

Martyn Porter, president of the British Orthopaedic Association said:

The BOA welcomes this report which shows a tremendous improvement in the care for frail, older patients with broken hips. We have seen improvements year-on-year because surgeons, doctors, nurses and therapists have all worked together, as a team, to enhance care of these patients. Rather than focus on a single target, the NHFD has tried to improve the whole pathway from hospital admission to ward care and surgery and then to rehabilitation and a quicker return home. More patients are now being evaluated for osteoporosis and so the system not only improves care for the current fracture but also tries to prevent the next one. The NHFD and its latest report is something Trauma and Orthopaedic Surgeons are proud to support.

Dr Helen Wilson, consultant general and geriatric medicine and British Geriatrics Society co-chair of National Hip Fracture Database (NHFD) said:

At a time when many services are struggling to find ways to manage the increasing numbers of frail elderly patients, this report is very encouraging; demonstrating that when clinicians from different specialties work together in a co-ordinated and collaborative way that significant and sustained improvements can be made in patient care.

Download a copy of the report from www.nhfd.co.uk

Notes to Editors

For further information or to arrange interviews contact Hannah Bristow, RCP Clinical Standards communications officer, Hannah.Bristow@rcplondon.ac.uk 020 3075 1447 or 07584 303 784.

The National Hip Fracture Database national report 2013 was commissioned by HQIP as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

The NHFD is an NHS success story: more and more patients are having prompt surgery; better access to specialist care for their medical problems; and to further treatment – in the form of medication to strengthen bone, and measures to prevent falls – to reduce the risk of future fractures.

With more than 250,000 cases now documented, the NHFD is the biggest audit of its kind in the world, and its success has led to its work being replicated in Ireland, which now has an Irish Hip Fracture Database, with similar developments in hand in Australia and New Zealand, Canada, and Hong Kong.

The NHFD was founded by the British Orthopaedic Association and the British Geriatrics Society between 2004 and 2007. In 2013 the NHFD moved to be managed as part of the Falls and Fragility Fracture Audit Programme (FFFAP) within the RCP London.


[1] Commissioning hip fracture care – the NICE way; British Geriatrics Society newsletter (February 2013)

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