The National Hip Fracture Database (NHFD) annual report 2016 details the care provided to the 65,000 patients aged 60 and over who sustained a hip fracture during 2015, as well as their outcomes and patient casemix. Patient care is audited against standards defined by the National Institute for Health and Care Excellence (NICE), and hospital performance in ward management, surgery and patient outcome is listed in the summary tables.
Hip fracture programme teams should:
- develop protocols to assess and monitor their patients, so better understanding of the nature and management of dementia can help to prevent delirium – the commonest complication of hip fracture
- consider adopting standardised, protocol-driven approaches to anaesthesia and surgical care
- consider whether theatre capacity and orthogeriatrician and therapist staffing is aligned to the times of day at which hip fractures commonly present
- develop a culture of continuous improvement – using NHFD performance run charts to evaluate the quality of their services
- ensure that clinical governance extends beyond the acute part of the patient pathway – to include rehabilitation, intermediate care and community elements
- ensure that robust processes allow the accurate collection of data on hip fractures – with particular attention to surveillance of complications and validity of casemix factors.
People who commission care should:
- develop a culture of continuous improvement – using NHFD performance run charts and other quality indicators to inform discussions with local provider organisations
- consider a whole pathway approach to commissioning hip fracture services – with particular attention to how the acute HFP team integrates with rehabilitation, intermediate care and community elements of the pathway
- ensure that 120-day follow-up is an integral part of patient care, and that acute hospital teams engage with rehabilitation and community services in follow-up of patients’ progress
- consider how their population is served by fracture liaison services (FLSs) to assess people at risk of falls and fragility fractures and deliver appropriate osteoporosis and fall prevention.
People who receive care should:
- use the NHFD’s My hip fracture care guide2 – to help them understand key elements of care that they may wish to discuss with the staff looking after them.
People who develop health policy should:
- consider the whole hip fracture pathway – so that they develop initiatives that incentivise quality and long-term outcomes, rather than being focused on acute care.
- British Geriatrics Society
- British Orthopaedic Association
- National Osteoporosis Society
- The Royal College of Surgeons
- Healthcare Quality Improvement Partnership (HQIP)