Improvements in fracture care in Ireland

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Improvements in fracture care in Ireland over the last five years were shown in the Irish Hip Fracture Database National Report 2017-2021.

The report, which included data from 3,806 cases who were aged 60 and over, in the six Hospital Groups showed:

  • The Irish Hip Fracture Standard (IHFS) 1 (percentage of patients admitted to an orthopaedic ward within four hours or admitted to theatre from emergency department within four hours) increased from 11% in 2017 to 26% in 2021.
  • Compliance with IHFS 2 (percentage of patients who received surgery within 48 hours) which was 69% in 2017, increased to 76% in 2021. Almost one-quarter (24%) of patients did not receive surgery within 48 hours of their admission to hospital in 2021. While this figure decreased from 30% in 2017, the report said it remained unacceptably high. ‘Awaiting medical review, investigation or stabilisation’ (35%) remained the most common reason for delay, followed by ‘Awaiting space on theatre list’ (14%). In 2021, a new reason was added in order to capture issues resulting from patients being on an anticoagulant as a reason for delay (9%).
  • IHFS 3 (percentage of patients who developed a pressure ulcer/injury) remained steady at 3% between 2017 and 2021.
  • IHFS 4 (percentage of patients seen by a geriatrician or advanced nurse practitioner) increased from 50% in 2017 to 83% in 2021.
  • IHFS 5 (percentage of patients receiving a bone health assessment)  increased from 73% in 2017 to 92% in 2021.
  • IHFS 6 (percentage of patients receiving a specialist falls assessment)  increased from 47% in 2017 to 85% in 2021.
  • IHFS 7 (percentage of patients mobilised on the day of or the day after surgery by a physiotherapist) increased from 73% in 2017 to 82% in 2021.

The report said that since the implementation of the Best Practice Tariff (BPT) in 2018, €2,091,000 had been paid out to the participating hospitals for compliance with the IHFS. The BPT had been a key driver in the improvement of standards of the IHFD. The meant length of stay (LOS) for hip fracture patients was 20.0 days in 2017 and 17.5 days in 2021. The median LOS decreased by 1 day, from 13 days in 2017 to 12 days in 2021.  Thirty percent of patients were discharged directly home from the acute hospital in 2021, compared with 22% in 2017, and 2% less patients were discharged as a new admissions into long-term care in 2021 compared with 2017.

Dr Brian Creedon, Clinical Director National Office of Clinical Audit  congratulated  Dr Emer Ahern and Prof Conor Hurson, National Clinical Leads Irish Hip Fracture Database National Office of Clinical Audit and Ms. Louise Brent, Audit Manager, “on an excellent report and for your continued efforts in developing and progressing this valuable quality improvement initiative. The IHFD audit continues to serve as an exemplar of quality improvement for all NOCA audits.”