The National Hip Fracture Database's (NHFD) new 2016 annual report for England, Wales and Northern Ireland on hip fracture surgery has found that not all patients are receiving properly planned care and rehabilitation after leaving hospital.
Findings show that collaboration between orthopaedic surgeons and geriatricians in coordinated hip fracture programmes has led to improved patient care in many areas, with two thirds of all hip fracture patients receiving ‘best practice’ care in hospital.
However, the authors caution that such collaborations appear to focus on the acute care of patients with little influence over longer term rehabilitation. They express concern that a number of hospitals are still delivering care under a traditional orthopaedic-led model despite national guidelines calling for multidisciplinary partnerships.*
Improving patient experience
The NHFD report evidences how access to a multidisciplinary programme of care and rehabilitation for older people after hip fracture surgery can improve patient experience, enhance their recovery and save money for the NHS by reducing length of stay in hospital and patient readmissions. It also calls for hip fracture programmes to cover the entire pathway of care for frail older people, from hospital admission to recovery, by involving rehabilitation and community services alongside surgical, medical and nursing care in a multidisciplinary team.
Among the recommendations outlined in the report, the NHFD paper calls for locally managed partnerships between clinicians and community service providers to extend all hip fracture programmes into post hospital care, as well as for hospital hip fracture teams to work with rehabilitation and community units to undertake a 120 day follow-up for all patients as an integral part of their care.
The report cites several examples of good practice, where cross-cutting partnerships linking hospital and community services are improving outcomes and reducing hospital bed occupation.
- Royal Berkshire Hospital, Reading – Where a new pathway includes early mobilisation and proactive discharge planning. Patients are placed under the care of specialist doctors in a dedicated specialist multi-disciplinary team providing post-operative care and rehabilitation. Patients are reporting enhanced care and average length of hospital stay has been reduced from 19.3 days to 15.2 days.
- St Peter’s Hospital, Ashford – Where the effectiveness of an early orthopaedic supportive discharge scheme has led to an overall reduction in the percentage of patients sent to rehabilitation and very positive feedback from patients.
But it also indicates there are many instances where hip fracture programmes do not include post hospital care and patients are losing out.
Dr Antony Johansen, NHFD clinical lead, orthogeriatric medicine said:
Collaboration between geriatricians and orthopaedic surgeons was key to NICE’s recommendation that patients are treated as part of a ‘hip fracture programme’. The NHFD has documented the success of such programmes in delivering improved hip fracture care, but many are still focused on the first hours and days of care.
Patients expect high quality care throughout their recovery. Teams in acute hospitals must link with colleagues in rehabilitation and social care if hip fracture programmes are to deliver such care, and to understand how this supports their patients’ recovery.
Jane McCormick, CQID communications manager, Royal College of Physicians
Direct line: 020 3075 1354
Mobile: 07990 745681
About the National Hip Fracture Database (NHFD)
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. In 2013 the NHFD moved to be managed as part of the Falls and Fragility Fracture Audit Programme (FFFAP) within RCP London.
About HQIP, the National Clinical Audit Programme and how it is funded
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.