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NHFD annual report 2017

In its tenth year, the National Hip Fracture Database (NHFD) annual report reached half a million records, representing a significant milestone for the data collectors who make the audit possible.

Key recommendations

  • 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
  • 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
  • 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 


Who's involved


Falls and Fragility Fracture Audit Programme

The NHFD is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by the Royal College of Physicians (RCP) as part of the Falls and Fragility Fracture Audit Programme (FFFAP) alongside the Fracture Liaison Service Database (FLS-DB) and Falls Prevention Audit. FFFAP aims to improve the delivery of care for patients having falls or sustaining fractures through effective measurement against standards and feedback to providers.

Healthcare Quality Improvement Partnership

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 hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Its purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

The Royal College of Physicians

The Royal College of Physicians (RCP) is a registered charity that aims to ensure high-quality care for patients by promoting the highest standards of medical practice. It provides and sets standards in clinical practice, education and training, conducts assessments and examinations, quality assures external audit programmes, supports doctors in their practice of medicine, and advises the government, the public and the profession on healthcare issues.