Wide Variation Among Hospital in Hip Fracture Care

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Wide variations among hospitals in complying with key areas of hip fracture care emerged in the National Report 2022 of the Irish Hip Fracture Database (IHFD), which called on the hospitals to examine and reduce the variations.

Dr Emer Ahern, Clinical Orthogeriatric Lead for the IHFD, said the report highlighted a number of positive strides in older adult care, “with notable improvements in post-surgery mobilisation, pre-operative nerve block, and delirium screening.” But there was “huge variance” across the hospitals, ranging from 13% to 99%.

The report called on each of the hospitals’ hip fracture governance committees (HFGC) to examine how to reduce these variations. “Lessons can be learned from hospitals that have successfully implemented quality improvements both in the Irish Hip Fracture Standards (IHFS) and in other areas of clinical care.”

With data coverage at 94% from 16 hospitals, and 3,909 cases (69%  female and 31%  male, with a mean age of 79), the report provides a comprehensive overview of hip fracture cases in Ireland.

Mr Terence Murphy, Clinical Orthopaedic Lead for the Irish Hip Fracture Database (IHFD)  emphasised the significant impact of the audit over the past ten years on elevating the standard of care for our older population.

“Hip fracture care in Ireland is a testament to the health services’ ability and will to prioritise and enhance the well-being of our older adults. The Irish Hip Fracture Database has played a crucial role in shaping and improving this care, and the standards set by the audit have been instrumental in this progress. Emphasising the importance of early mobilisation, we have witnessed transformative outcomes for patients. It not only contributes to a shorter hospital stay but also enhances overall recovery, leading to improved outcomes. This underscores the pivotal role early mobilisation plays in further improving the standard of care for people recovering after hip fracture surgery.”

Key findings:

• 74% of patients received surgery within 48 hours of admission.

• 78% of patients received a pre-operative nerve block for pain. This pain-management intervention reduces opioid reliance and improves pain control pre- and postoperatively.

• 80% of patients received a specialist falls assessment.

• 88% of patients received a bone health assessment.

• 80% of patients were seen by a geriatrician or advanced nurse practitioner.

• 86% of patients were mobilised by a physiotherapist on the day of surgery or the day after surgery.

• 29% of patients were discharged directly home from hospital, an increase from 20% in 2018. This shift reflects improved orthogeriatric services, early mobilisation after surgery, and initiatives like early supported discharge pathways.