5th September 2012 – Care improves for older people with hip fractures

Posted on September 5, 2012 by AireAdmin

Airedale Hospital has scored highly in a new report published yesterday ranking trusts throughout the country on the care they provide for people with hip fractures.

It is based on the submissions to the National Hip Fracture Database (NHFD) which was developed as an independent survey, with support from the British Orthopaedic Association (BOA) and the British Geriatrics Society (BGS) and recognised as a national clinical audit in 2009.

The report covers data submitted by 180 hospitals between 1 April 2011 and
31st March 2012 and the total number of cases was 59,365.

Julie Livesey, general manager for trauma and orthopaedics at Airedale NHS Foundation Trust, said: “We are absolutely delighted with our first set of results which demonstrate that the whole multidisciplinary team has worked hard on improving the care for patients which is shown in our 83% rate of patients receiving surgery within 48 hours.

“The NHFD network acknowledges that hospitals are unlikely to achieve any higher than 85-90% as there will always be some patients too ill to undergo surgery within the timeframe.

“We are involving our patients in every step of their care pathway to make sure that they understand any treatment plans so they and their families can work with us to improve their recovery.”

Orthopaedic consultant, Gethin Thomas, from Airedale NHS Foundation Trust, said: “We are really proud of these results. We have an excellent multi-disciplinary team and employing an orthopaedic nurse practitioner has helped us to achieve them.

“By using the principals of enhanced recovery we have reduced the length of time patients stay in hospital, reduced pain and blood loss during surgery and helped them to get better quickly.”

Data relates to six standards:- prompt admission to orthopaedic care; surgery within 48 hours and within normal working hours; nursing care aimed at minimising the risk of pressure ulcers; routine access to orthogeriatric medical care; assessment and appropriate treatment to promote healthy bones; and falls assessment. It also includes surgery within 36 hours to meet the needs of a Best Practice Tariff initiative.

The aim of collecting the data is to improve the care for people suffering from hip fractures and to prevent them from happening – as it is the more common serious injury of older people. This type of injury is likely to become more common as the population ages. Many hip fracture patients are already frail, and for them the injury poses the greatest risk of loss of independence. It is estimated that it costs more than £2 billion a year for the UK to care for these patients taking into account hospital care and the care needed if they lose their independence.

Data from Airedale NHS Foundation Trust shows there were 249 hip fractures during the past year.

  • 83% received surgery within 48 hours (the other 17% were delayed for medical rather than logistical reasons – it could be that they were not medically fit for an operation)
  • 66.4% were admitted to an orthopaedic ward within four hours
  • 93.8% were discharged on bone protection medication
  • 99.6% had a falls assessment prior to discharge
  • 59% were assessed by an orthogeriatrician before an operation (however, all our patients with hip fractures will be assessed at some point by an orthogeriatrician during regular ward rounds but not necessarily before an operation)
  • 2.7% developed pressure ulcer
  • The average length of stay in Airedale Hospital with hip fractures was 15 days, which is good in comparison with others and we are looking at other areas which will help reduce this further.

This was the first time that Airedale NHS Foundation Trust had submitted such data.
In comparison, the national findings were:-

  • 83% receive surgery within 48 hours (down from 87% in 2011)
  • 52% of patients are admitted to an orthopaedic ward within four hours (down from 56% in 2011)
  • 69% are discharged on bone protection medication (up from 66%)
  • 92% received a falls assessment prior to discharge (up from 81%)
  • 43% are reported as assessed by an orthogeriatrician before an operation (up from 37%)
  • 3.7% are reported as having developed pressure ulcers (no change)

A team of staff from Airedale Hospital were nominated as finalists in the musculoskeletal care category of the national Care Integration Awards for 2012 for their work to improve the care of patients with hip fractures – particularly for people aged 60 and over.

One of the main improvements they have made is encouraging the orthopaedics and older people’s medicine departments to work more closely together particularly around falls prevention and bone health. Also the team has also increased the number of patients following all seven of the best practice criteria for the fractured neck of femur pathway to around 80% within just 12 months.

The multi-disciplinary team works to support patients with appropriate rehabilitation services, advice, aids and adaptations to help them to stay mobile and independent.

Clinicians and managers have used these results to help monitor and improve the quality of hip fracture care. The data allows us to benchmark against other similar hospitals.