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Length of hospital stay for hip fracture falls by a day, audit shows

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5940 (Published 04 September 2012) Cite this as: BMJ 2012;345:e5940
  1. Susan Mayor
  1. 1London

The length of stay in acute wards for patients admitted to hospital with a hip fracture has fallen by an average of one day—to just over 20 days—over the past year, concludes the latest report from the national hip fracture database for England, Wales, Northern Ireland, and the Channel Islands.1

The 5% reduction in average acute hospital stay (from 21.2 days in 2011 to 20.2 days in 2012) saved around £14m (€17.7m; $22.3) in hospital bed costs, estimate the reports’ authors, from the British Orthopaedic Association and the British Geriatrics Society.

The audit, now in its fourth year, reviewed the care and outcomes of 59 365 patients with hip fracture admitted to 180 hospitals between 1 April 2011 and 31 March 2012.

Its results showed that 43% of patients were assessed by an orthogeriatrician, up from 37% in 2011.

Just over two thirds (67%) of patients had surgery within the target period of 36 hours after admission, up from 62% in 2011. And more patients also underwent a falls assessment before discharge (92% versus 81%).

Colin Currie, the database’s clinical lead on geriatric medicine, considered that collaborative care in which orthopaedic surgeons work with geriatricians is one of the major factors that has improved the quality of care for hip fracture patients. He said, “This ensures prompt preoperative assessment so patients can undergo surgery quickly. And attention on developing medical complications means that any problems are spotted and managed early.”

Careful assessment of why falls occurred and how further falls can be prevented and effective multidisciplinary rehabilitation are also improving hip fracture care.

Currie considered that the continuous audit and feedback provided by the hip fracture database has been very useful to clinical teams, providing ‘bundles of awareness, knowledge and data.’

“Teams can see how they are doing compared with previously and compared with other hospitals. And it’s a very supportive audit, providing lots of advice, information, and examples of how other people have used the audit to change how they do things.”

But more needs to be done in post-acute care of hip fracture, he said. The latest annual figures show large variations in total length of NHS stay (how long patients remain in hospital rather than just on an acute ward) and in the numbers of patients able to return to their own homes rather than requiring care in a nursing home.

“We need to get better at following hip fracture patients up at 30 and 120 days,” Currie said. Possible reasons for the variation in total length of stay in hospital may include case mix and availability of early and community rehabilitation and specialist early supported discharge schemes. The audit will report further on overall length of hospital stay later this year, which will help to clarify reasons for the differences.

A further report from the British Orthopaedic Association calls for the development of national guidelines and clinical pathways in England to streamline referrals from GPs to ensure that patients needing orthopaedic surgery get the best treatment.2

The report’s author, Timothy Briggs, consultant orthopaedic surgeon at the Royal National Orthopaedic Hospital and vice president elect of the British Orthopaedic Association, set out recommendations on how to improve the quality of orthopaedic surgery in the face of cost savings in the NHS and the growing elderly population.

He suggested developing networks of hospitals and centres to form specialist orthopaedic units to carry out complex surgery such as revisions of hip and knee replacements. “These would make sure that appropriate expertise is applied first time, every time, to improve the survival rate of implants, reduce complications and infection, and consequently reduce litigation costs,” he said.

Notes

Cite this as: BMJ 2012;345:e5940

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