The National Hip Fracture Database (NHFD) commissioners’ report highlights today, that Clinical Commissioning Groups (CCGs) in England should question the length of stay for rehabilitation beds they commission in community hospitals and care homes for hip fracture, and other conditions affecting older people because NHS information systems are not reliably recording this information. They should also investigate the quality of care at the hospitals in their area.
The NHFD commissioners ‘ report is aimed at Clinical Commissioning Groups (CCGs) in England and in particular, commissioners who commission services for hip fracture, trauma and care for older people.
This report should also be used alongside the recently published NHFD annual report to fully understand the quality of hip fracture services in their area. This can be found on the NHFD’s website.
Main key recommendations include:
- CCGs should challenge any local hospitals where fewer than 70% of patients receive the prompt surgery recommended by NICE CG124 (that states patients with hip fractures should have surgery on their first or second day in hospital)[1]
- Some CCGs (1.4%) will need to question why more than 80% of their local population do not receive treatment in a hip fracture programme (HFP), a model of care that was central to NICE guidance
- 1 in 9 CCGs should consider why fewer than half of their patients were able to be mobilised out of bed on the day following surgery, and question whether this reflects poor control of hydration, or a failure to provide the early physiotherapy assessment recommended in NICE QS16
Where poor performance is highlighted in this report, CCGs will wish to examine their local hospitals’ performance, as detailed in the colour coded performance tables of the NHFD annual report and in individual hospital dashboards available on the NHFD website.
Dr Antony Johansen, NHFD clinical lead for geriatric medicine said:
'An effective hip fracture programme will consider a patient’s treatment not only during their acute hospital stay, but throughout their rehabilitation and recovery. This pathway of care is complex, and relies on working between secondary and community care providers. Commissioners of hip fracture services will want to ensure the quality of care is maintained throughout, and that the implications of post-acute rehabilitation in terms of both cost and quality are fully understood.'
The NHFD commissioners’ 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. Full details can be found at www.nhfd.co.uk.
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.
Hip fracture is common, with 60,000 injuries each year across England. 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 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).
[1] National Institute for Health and Care Excellence, 2011. The Management of hip fracture in adults – clinical guideline CG124. www.nice.org.uk/guidance/CG124