The sixth National Hip Fracture Database (NHFD) report today revealed that over 64,000 hip fracture injuries take place each year. This leads to the occupation of over 4,000 inpatient beds at any one time across England, Wales and Northern Ireland, which equates to 1 in 40 of all NHS beds.
The latest NHFD report shows that 64,102 patients were admitted to hospital with a hip fracture between 1 January and 31 December 2014.
Hip fracture is an ideal marker of the quality of care given to frail and older patients in the NHS. The care of hip fracture patients is complex, involving a wide range of specialists, clinical teams, healthcare departments and agencies. The NHFD report aims to improve efficiency of care after hip fracture, to prevent second fracture and, overall, to improve early intervention to restore patients’ independence.
Hip fracture patients face a significant risk of dying or of losing their independence, and their recovery is dependent on how well hospital and community services work together. The NHFD report details variation in practice around the UK, supporting the development of the best way to care for the frail and older patients who experience hip fracture injuries.
This latest NHFD report reveals a national improvement across all standards when directly compared with last year’s report.
Mr Rob Wakeman, NHFD clinical lead, orthopaedic surgery said:
Hip fracture is a major cause of death and disability in older people who fall. Our results show a gradual overall improvement in the quality of care offered, but some hospitals have a deteriorating service, while others have failed to make significant progress. From the recommendations of the report, I encourage local hospitals and their commissioners to find ways to improve these services.
The report’s main findings include:
- more patients (72.1%) now receive surgery on their first or second day in hospital but there remains unacceptable variation; different units reported figures ranging from 14.7% to 95.3%
- more patients are now offered total hip replacement but this was still only performed in 20.6% of the 15,685 patients who met the clinical criteria for this procedure
- three-quarters (73.3%) of patients were mobilised from bed on the day after surgery but 21 hospitals (11.7%) achieved this in fewer than half of cases
- more patients (85.3%) received orthogeriatric assessment in the peri-operative period but seven units (4%) reported that they still had no orthogeriatric service
- hip fracture teams may lack influence over post-acute rehabilitation and only six (3%) hospitals reported that their local community rehabilitation team was represented at their monthly hip fracture programme clinical governance meetings.
The report’s key recommendations include:
- staff in hip fracture programmes should consider the purpose of monthly clinical governance meetings that are central to improving care in individual units
- hospital managers should challenge areas that require improvement, such as the variation in rates of prompt surgery
- commissioners should use this report to understand the performance of hospitals from which they are commissioning services, for example, how well integrated hospital and community health services work.
The NHFD audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit (NCA) Programme.* The NHFD audit is managed by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians (RCP) as part of the Falls and Fragility Fracture Audit Programme (FFFAP).
- For more information or to arrange an interview, please contact Joanna Morgan, communications manager, RCP Care Quality Improvement Department, on 020 3075 1354.
- The full report can be found on the NHFD website.
- The NHFD was founded by the British Orthopaedic Association and the British Geriatrics Society in 2004. In 2013 the NHFD moved to be managed as part of FFFAP within the RCP London. The NHFD is a clinically led, web-based audit of hip fracture care and secondary prevention. All 180 eligible hospitals in England, Wales and Northern Ireland are now regularly uploading data to the NHFD.
*HQIP, the NCA Programme and how it is funded
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 commission and develop the NCA Programme, which comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.
The NCA Programme is funded by NHS England, the Welsh government and, with some individual audits, also funded by the Health Department of the Scottish government, Department of Health, Social Services and Public Safety (DHSSPS) Northern Ireland and the Channel Islands.