National Hip Fracture Database Kuntal Patel MS(Orth), MRCS(Ed.), Dip SEM (GB & I), MSc (Sports Injuries), MSc (Orthopaedics), FRCS (T & O) Consultant Orthopaedic Surgeon Honorary senior clinical lecturer – Edge Hill University
Regional Data for North West Hospitals Number of submitted # Fracture NOF 500 458 450 403 400 382 400 354 319 350 273 300 249 247 229 250 206 200 164 157 120 121 150 100 50 0
Measures taken in the last 12 months • Hip Fracture pathway • Regular MDT • Training of nurses for AMTS assessment • Junior doctor education • Robust induction • Increase in no. of T/L • Consultant lead for trauma
Time to Surgery <36 hours RLI FGH 100% 84% 80% 73% 68% 57% 56% 55% 60% 40% 20% 0% April 2010 - March 2011 April 2011 - March 2012 April 2012 - Dec 2012 (RLI n=264 FGH n=102) (RLI n=282 FGH n=125) (RLI n=186 FGH n=91)
Reason if >36 hours RLI Theatre space Medical review Ortho review Other 100% 80% 61% 55% 60% 49% 40% 31% 21% 20% 14% 20% 12% 11% 9% 9% 6% 0% April 2010 - March 2011 April 2011 - March 2012 April 2012 - Dec 2012 (n=116) (n=123) (n=51)
Reason if >36 hours FGH Theatre space Medical review Ortho review Other 100% 80% 60% 53% 40% 40% 40% 31% 31% 29% 28% 24% 20% 10% 7% 7% 0% April 2010 - March 2011 April 2011 - March 2012 April 2012 - Dec 2012 (n=29) (n=42) (n=15)
Specialist Falls Assessment RLI FGH 100% 98% 99% 100% 87% 80% 60% 40% 20% 1% 0% 0% April 2010 - March 2011 April 2011 - March 2012 April 2012 -Dec 2012 (RLI n=264 FGH n=102) (RLI n=282 FGH n=125) (RLI n=186 n=91)
Bone Medication Assessment RLI FGH 100% 100% 100% 95% 80% 69% 60% 40% 29% 25% 20% 0% April 2010 - March 2011 April 2011 - March 2012 April 2012 - Dec 2012 (RLI n=264 FGH n=102) (RLI n=282 FGH n=125) (RLI n=186 FGH n=91)
Admitted using joint protocol RLI FGH 100% 98% 97% 100% 80% 68% 60% 40% 20% 0% April 2011 - March 2012 April 2012 - Dec 2012 (RLI n=282 FGH n=125) (RLI n=186 FGH n= 91)
Geriatrician assessment <72 hours RLI FGH 100% 93% 78% 80% 59% 60% 46% 40% 20% 0% April 2011 - March 2012 April 2012 - Dec 2012 (RLI n=282 FGH n=125) (RLI n=186 FGH n=91)
MDT rehab assessment RLI FGH 98% 98% 100% 92% 80% 66% 60% 40% 20% 0% April 2011 - March 2012 April 2012 - Dec 2012 (RLI n=282 FGH n=125) (RLI n=186 FGH n=91)
Pre-op AMTS RLI FGH 100% 89% 82% 80% 60% 40% 20% 0% April 2012 - Dec 2012 (RLI n=171 FGH n=81)
Pre-op AMTS RLI FGH 97% 100% 93% 88% 87% 80% 72% 55% 60% 40% 20% 0% Q1 Q2 Q3
Post-op AMTS RLI FGH 100% 85% 80% 60% 54% 40% 20% 0% April 2012 - Dec 2012 (RLI n=171 FGH n=81)
Post-op AMTS RLI FGH 96% 100% 92% 79% 80% 56% 60% 49% 40% 28% 20% 0% Q1 Q2 Q3
Pressure ulcers 10 8.8 9 7.5 8 7 6 5 5 4.4 4 3.9 4 3.4 2.9 3 2.3 2.1 2 1.3 1 0.9 0.8 0.5 1 0
Bone protection medication 120 99.6 100 97.1 96.2 96.5 96.5 94.1 100 92 92.3 90.7 86.8 80.3 80 64 60 40 31.8 31.7 20 0
Surgery within 48hrs and during working hours 100 93.8 92.4 92.2 88.6 90 83.2 82.4 78.2 75.7 75.3 80 73.6 71.9 70.2 70.3 65.8 70 61.4 60 50 40 30 20 10 0
RLI vs England 100 92.8 93.1 89.8 90 84.2 80 73.6 70 64 60 52.2 49.9 49.8 50 40 Royal Lancaster Infirmary 30 23.8 22.3 19.7 English average 20 15.8 13.8 8.5 10 4 3.9 0.9 0
Conclusion Hip fractures are the commonest serious injury of older people which result in increased morbidity and mortality The safe, effective, and timely management of patients presenting with hip fractures is fundamental in the practice of Trauma & Orthopaedic Surgery Multi-disciplinary approach and understanding of collective goals and objectives in management are essential Improvements in the rate of achievement of BPT measures will not only lead to higher quality of care for patients with hip fractures, but also additional funding for the department
Thank you
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