title: Timely delivery of hip fracture care: a Middlemore Hospital audit.
abstract: BACKGROUND
  New Zealand (NZ) hospitals lack a centralised audit process to evaluate hip fracture care whereas UK hospitals audit hip fracture care in relation to best practice guidelines. This study sought to evaluate multiple factors in hip fracture care at Middlemore Hospital (MMH). Comparisons were made with an audit from MMH in 2008 and a multicentre UK audit.
  
  
  METHODS
  A retrospective audit of patients with hip fractures was carried out at MMH between January and June 2012.
  
  
  RESULTS
  120 patient charts were reviewed. In 2012, 14.2% of patients were admitted from ED within the guideline recommended period of four hours compared to 5.6% of patients in 2008. 72.5% received operative management within the guideline suggested period of 48 hours in comparison to 51% in 2008. Lack of available theatre space accounted for 51% of delays in 2008.
  
  
  CONCLUSIONS
  There have been considerable improvements to timely delivery of hip fracture care at MMH between 2008 and 2012. However, there are ongoing delays to ward admission and operative management at our institution resulting in care that falls beyond the times recommended by international guidelines. The lack of available theatre space remains a major cause of delayed surgery. We advocate the development of a multicentre audit in NZ hospitals.
authors.affiliation: Department of Surgery, Auckland City Hospital, Auckland, New Zealand. ushan.de@gmail.com.
authors.forename: C Ushan
authors.initials: CU
authors.lastname: De Silva
authors.forename: Hla S
authors.initials: HS
authors.lastname: Tha
authors.forename: Delwyn
authors.initials: D
authors.lastname: Armstrong
authors.forename: Kathy
authors.initials: K
authors.lastname: Walker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008485:Medical Audit; D009520:New Zealand; D019637:Orthopedic Procedures / Q000592:standards / Q000706:statistics & numerical data; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data