title: Implementing the National Hip Fracture Database: An audit of care.
abstract: BACKGROUND
  Hip fractures are common injuries in the elderly, with significant associated morbidity and mortality rates. The National Hip Fracture Database (NHFD) was implemented to audit care according to national standards thus improving its clinical and cost-effectiveness.
  
  
  METHODS
  We retrospectively examined the care pathway for all hip fractures after its introduction at our centre over 1 year, with an audit of care according to the BOA-BGS 'Blue Book' guidelines. Data between the first (period 1: initial audit) and second (period 2: re-audit) six months of the study period were compared.
  
  
  RESULTS
  There were 372 patients (28% male, 72% female) in total with 190 in period 1 and 182 in period 2. For all patients, the median age was 85 years (range 33-101) and the median time to surgery was 24.5h (1-519.3), with 251 (67.5%) within 36h. Surgical delay was mainly due to lack of theatre space (37.6%) and medical reasons (54.7%). The median length of stay was 11 days (2-92) and the inpatient mortality rate was 6.2% (23). When comparing the two study periods, there were significantly more patients undergoing falls (p<0.01) and bone protection (p<0.01) assessments in period 2. Lack of theatre space was a significantly less common (p<0.01), with a significantly shorter median time to surgery (p=0.01) and length of stay (p<0.01) in period 2. More patients were discharged to rehabilitation units and the mortality rate was non-significantly lower in period 2 (7.4% vs. 5%). The best practice tariff was met in 45.3% and 70.3% (p<0.001) of patients in periods 1 and 2 respectively providing a total income of £95230.00 (GBP).
  
  
  CONCLUSIONS
  Implementing the NHFD has led to an improvement the quality of hip fracture care according to national guidelines. More patients were assessed by an orthogeriatrician, with a shorter time to surgery and length of stay following re-audit. There is potential for an improvement in mortality rates as well as significant financial income for hospitals.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames KT2 7QB, UK. Electronic address: niravpatel@doctors.org.uk.
authors.forename: Nirav K
authors.initials: NK
authors.lastname: Patel
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Sarraf
authors.forename: Sarah
authors.initials: S
authors.lastname: Joseph
authors.forename: Chooi
authors.initials: C
authors.lastname: Lee
authors.forename: Fiona R
authors.initials: FR
authors.lastname: Middleton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005265:Femoral Neck Fractures / Q000534:rehabilitation / Q000628:therapy; D006620:Hip Fractures / Q000534:rehabilitation / Q000628:therapy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014850:Waiting Lists
keywords: Care standards; Hip fractures; Multidisciplinary team; National Hip Fracture Database; Outcomes