The National Hip Fracture Database's (NHFD's) ninth annual report shows that while more patients are receiving early surgery and surviving a hip fracture, two in five are not receiving all of the recommended elements of a hip fracture programme that represent ‘best practice’.
The NHFD report analyses the process and outcomes of care of nearly 65,000 people who presented with a hip fracture across 177 hospitals. It reports much good practice within inpatient care, with the majority of patients getting prompt surgery, specialist geriatric assessment and consideration of their nutritional status.
But, across the country nearly 40% of patients are still not receiving the full package of care that represents best practice and are missing out on important clinical assessments that will improve their rehabilitation and recovery after this serious injury. In addition, in England, the full package attracts the £1,335 additional payment of Best Practice Tariff (BPT), so hospitals are missing out on potential income.
Some of the other key findings of the latest report include:
Antony Johansen, geriatrician clinical lead for the NHFD said:
The elements of care that define best practice in England are designed to encourage teams to deliver key elements of a hip fracture programme – a multidisciplinary, patient-centred approach that considers the wider health of frail people with this potentially life-changing injury.
If 40% of patients are not receiving this care – usually because they miss out on just one or two elements, this could compromise their rehabilitation and recovery. If this figure could be halved then a typical unit seeing 360 cases a year would attract an additional £100,000 in BPT each year – an obvious target in financially challenging times.
NHFD is an NHS quality improvement programme that has dramatically improved the care of elderly people admitted to hospital with a hip fracture. Now in its tenth year, the database has continuously collected data on all over 60 year olds with a hip fracture in England, Wales and Northern Ireland. During this time, more than half a million patient records have been submitted, enabling comprehensive monitoring of patient care from admission to hospital through to post-discharge follow-up.
Reporting on NHFD data has contributed to major improvements in patient treatment and care, including:
Joanna Morgan, CQID communications manager, Royal College of Physicians
The National Hip Fracture Database (NHFD) documents major innovations in collaborative working between orthopaedic surgeons and geriatricians which drive improved care for patients requiring emergency hip fracture surgery. Its annual report collates this data.
The NHFD is a clinically led, web-based quality improvement initiative commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by the Royal College of Physicians (RCP). The NHFD was founded by the British Orthopaedic Association and the British Geriatrics Society between 2004 and 2007. It has collected data since 2007. In 2012 the NHFD moved to be managed as part of the Falls and Fragility Fracture Audit Programme (FFFAP) within RCP London.
The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.
More information, including audit reports, can be found at the NHFD website.