title: Quality improvement for patients with hip fracture: experience from a multi-site audit.
abstract: OBJECTIVE
  The first East Anglian audit of hip fracture was conducted in eight hospitals during 1992. There were significant differences between hospitals in 90-day mortality, development of pressure sores, median lengths of hospital stay, and in most other process measures. Only about half the survivors recovered their pre-fracture physical function. A marked decrease in physical function (for 31%) was associated with postoperative complications.
  
  
  METHODS
  A re-audit was conducted in 1997 as part of a process of continuing quality improvement. This was an interview and record based prospective audit of process and outcome of care with 3 month follow up. Seven hospitals with trauma orthopaedic departments took part in both audits. Results from the 1992 audit and indicator standards for re-audit were circulated to all orthopaedic consultants, care of the elderly consultants, and lead audit facilitators at each hospital.
  
  
  METHODS
  Processes likely to reduce postoperative complications and improve patient outcomes at 90 days.
  
  
  METHODS
  As this was a multi-site audit, the project group had no direct power to bring about changes within individual NHS hospital trusts.
  
  
  RESULTS
  Significant increases were seen in pharmaceutical thromboembolic prophylaxis (from 45% to 81%) and early mobilisation (from 56% to 70%) between 1992 and 1997. There were reduced levels of pneumonia, wound infection, pressure sores, and fatal pulmonary embolism, but no change was recorded in 3 month functional outcomes or mortality.
  
  
  CONCLUSIONS
  While some hospitals had made improvements in care by 1997, others were failing to maintain their level of good practice. This highlights the need for continuous quality improvement by repeating the audit cycle in order to reach and then improve standards. Rehabilitation and long term support to improve functional outcomes are key areas for future audit and research.
authors.affiliation: General Practice & Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: C
authors.initials: C
authors.lastname: Freeman
authors.forename: C
authors.initials: C
authors.lastname: Todd
authors.forename: C
authors.initials: C
authors.lastname: Camilleri-Ferrante
authors.forename: C
authors.initials: C
authors.lastname: Laxton
authors.forename: P
authors.initials: P
authors.lastname: Murrell
authors.forename: C R
authors.initials: CR
authors.lastname: Palmer
authors.forename: M
authors.initials: M
authors.lastname: Parker
authors.forename: B
authors.initials: B
authors.lastname: Payne
authors.forename: N
authors.initials: N
authors.lastname: Rushton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006302:Health Services Research; D006620:Hip Fractures / Q000534:rehabilitation / Q000601:surgery*; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D008297:Male; D008485:Medical Audit; D009985:Orthopedics / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D020127:Recovery of Function; D013222:State Medicine; D013503:Surgery Department, Hospital / Q000592:standards*; D017749:Total Quality Management; D006113:United Kingdom