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One in five hip fracture patients discharged directly home following surgery

Only one in five hip fracture patients were discharged home directly following surgery, according to the Irish Hip Fracture Database National Report 2017.

The report was launched by Dr Emer Ahern, Clinical Geriatric Lead for the Irish Hip Fracture Database.

The purpose of the report was to highlight the importance of the standardisation and optimisation of hip fracture care and continual measurement and monitoring of data to improve outcomes for patients.

In 2017, there were 3,608 patients aged 60 years or over hospitalised following a hip fracture.

The IHFD collected data on 95% (3,497) of cases from all sixteen acute hospitals. There is significant morbidity and mortality associated with this common injury and health care costs are high.

Speaking at the launch of the report, Dr Ahern said “Every day in Ireland, ten people break their hips. Only one in five go home directly from hospital. There has been huge progress in hip fracture care in Ireland in the past ten years and we will continue to use the data we collect to continually improve the care and outcomes for our patients.’’

Key Findings of the report were:

  • Ninety two per cent of patients were brought directly to the operating hospital, an increase of 5% from 2016.
  • Eleven per cent of patients were admitted to an orthopaedic ward within four hours.
  • Sixty nine per cent of patients received surgery within 48 hours of their admission to the Emergency Department.
  • Fourteen hospitals reduced the pressure ulcer incidence.
  • Seventy seven per cent of patients were mobilised on the day of or day after surgery.
  • One in two (50%) patients were reviewed by a Geriatrician in hospital
  • Seventy three per cent of patients received a bone health assessment to prevent further fractures.
  • The median length of stay had increased to 13 days.
  • Just over one in five (22%) of patients were discharged directly home from hospital.
  • The average age of a person who broke their hip was 80.
  • Eighty two per cent of hip fracture patients were admitted from home.
  • Ten per cent were admitted from a nursing home or other long stay facility and eight per cent of patients were transferred from another acute hospital.
  • There was 95% data coverage for 2017, an increase of 9% since 2016.

This report included individual hospital comparison across six key care standards and highlights variation in hospital performance across all six standards.

The report made the following recommendations:

Hospital governance

  • Development of a Hip Fracture Governance Committee (HFGC) in each hospital supported by the guidance issued by the National Office of Clinical Audit (NOCA). The HFGC to have a clear focus on quality improvement to reduce variability in the standards of care.

Clinical care

  • HFGC to standardise pathways of care for hip fracture patients to ensure timely access to orthopaedic ward or theatre.
  • Hospitals to provide surgery and early mobilisation to patients with hip fractures seven days per week.
  • Hospitals to provide an orthogeriatric service for all hip fracture patients.

Data quality

  • Hospitals to submit data in a timely manner to achieve above 90% data coverage quarterly and annually.
  • NOCA in collaboration with the Healthcare Pricing Office (HPO) continue to enhance the functionality of the IHFD Portal to include additional data quality checks and reporting.