Hospital services for trauma should be resourced

Each hospital providing hip fracture surgery should be resourced to provide a seven day a week service to trauma patients – including prompt access to theatre, medical support and early mobilisation by a physiotherapist, it was recommended in the Irish Hip Fracture Database National Report 2016.

The purpose of the report is 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.

The report showed that last year, in Ireland, 3,629 patients aged 60 years or over were hospitalised following a hip fracture.

The IHFD collected data on 3,159 cases from all sixteen acute hospitals which accounted for 86% of all hip fracture cases nationally. There are significant morbidity and mortality issues associated with this common injury and health care costs are high.

The report included individual hospital comparison across six key care standards and it highlighted huge variation in hospital performance across all six standards.

Key findings and recommendations from the Report were presented by Dr Emer Ahern, Irish Hip Fracture Database Clinical Geriatric Lead.

Key Findings:

  • 14% of patients were admitted to an orthopaedic ward within four hours.
  • 6% of patients went straight to theatre from the emergency department.
  • There was an increase in the percentage of patients having surgery within 48 hours (75%).
  • 77% of patients were mobilised on the day of or day after surgery.  Ninety three per cent those were mobilised by a physiotherapist.
  • There was an increase in the percentage of patients seen by a Consultant Geriatrician.  Fifty six per cent were seen at any time during their admission by a Consultant Geriatrician.
  • More patients received a bone health (57%) and falls (54%) assessment to prevent further falls and fractures.
  • The median length of stay had reduced to 12 days.
  • Data coverage (86%) and data quality (98%) had improved.
  • The average age of people who broke their hip was 80 years and over two-thirds were female.
  • Hip fractures usually occurred following a fall at home. In 2016, 81% of hip fracture patients were brought to hospital from their home.

The Report also recommended that:

  • Every hospital participating in the IHFD should have a hip fracture committee to ensure that the data from the IHFD was being used to drive
  • Continuous quality improvement in hip fracture care. IHFD audit reports should also be made available to the Hospital and Hospital Group Quality and Safety Committee.  It said NOCA would provide guidance and support to all of the local hip fracture committees.
  • Each hospital participating in the IHFD should provide a multidisciplinary orthogeritaric service.

The report said NOCA would continue to work with hospitals directly to put processes in place to support the current dataset and new data points to assure data quality and thereby supporting the provision of high quality reporting.

NOCA was established in 2012 to create sustainable clinical audit programmes at national level.