NHFD annual report 2017

Key recommendations

Leadership

• hospitals should ensure that the clinical leadership is in place to deliver and audit high-quality care
• local NHFD leadership should expand to include an anaesthetist as well as an orthopaedic surgeon and an orthogeriatrician

Inpatient falls

• Recommendation – hospital managers and clinicians should examine how ward environments and staffing contribute to risk of inpatient falls, and monitor local inpatient hip fracture incidence as a patient safety metric in their trust

Prompt surgery

• monthly clinical governance meetings should review local NHFD data to identify and target common avoidable clinical and organisational reasons for delay in surgery

Fracture management 

• hospitals and commissioners should determine the reasons for failure to follow NICE guidance in their local area
• hospitals and commissioners should review their ability to deliver total hip replacement to appropriate patients, in the light of NICE’s 2017 update on this topic

Rehabilitation

• Recommendation – hospitals and commissioners should examine the reasons for delay in admission to beds where patients can receive coordinated multidisciplinary care from the hip fracture programme team who will be responsible for their whole stay

Follow-up

• hospitals and commissioners should note the importance of supporting patients’ persistence with bone health medication, as without it, further fragility fractures will not be avoided

Length of stay

• Recommendation – hospitals and commissioners should use the opportunity of the ongoing Physiotherapy Hip Fracture Sprint Audit to improve their understanding of patient flows through different local services and their ability to capture the whole NHS super-spell

Best practice

• hospitals should review why individuals fail to receive all of the elements of care that define a hip fracture programme, since most cases fail on only one or two criteria