The Best Practice Tariff helps improve management of neck of femur fractures: a completed audit loop.
BACKGROUND
The Best Practice Tariff incentivizes hospitals in the UK to improve the care they deliver, and includes a requirement to deliver multiprofessional care to patients with neck of femur fractures. The Best Practice Tariff for 2010-11 included six targets: (1) surgery within 36 hours, (2) admission under consultant-led joint orthopaedic-geriatric care, (3) admission using a multidisciplinary assessment protocol, (4) review by a geriatrician within 72 hours, (5) geriatrician-directed multi-professional rehabilitation, and (6) assessment for falls and bone protection. The authors chose to audit their Trust's compliance with these targets.


METHODS
A retrospective audit was conducted in 2011 at the authors' university-affiliated tertiary care hospital, which is a regional major trauma centre. Only patients 65 years or older, with fragility-type neck of femur fractures who were treated surgically at the authors' unit and were eligible for geriatric review and multiprofessional rehabilitation, were included. The results of this audit (2010-11 Best Practice Tariff targets) were analysed and a series of procedural and logistical measures were introduced. A re-audit was performed in April 2012 for 2011-12, and the results for the 2 years were compared using appropriate statistics (Chi square tests and analysis of variance). Thirty-day mortality was compared using the summary hospital-level mortality indicator.


RESULTS
A total of 410 patients were eligible for Best Practice Tariff in 2010-11, which increased to 463 in 2011-12. The changes from the first year's audit helped increase the rates for 36-hour surgery from 48.3% to 73.4% and for 72-hour geriatric review from 68.8% to 81.8% (P<0.05). The annual Best Practice Tariff achievement increased from 31.7% to 61.3% (P<0.05). The summary hospital-level mortality indicator declined from 96.5 to 61.3.


CONCLUSIONS
Focusing on poorly satisfied Best Practice Tariff indicators can produce a significant improvement in the per capita Best Practice Tariff achievement. Further studies are needed to assess the health and financial gain in detail.
Specialty Trainee in Trauma and Orthopaedics, in the Department of Trauma and Orthopaedics, James Cook University Hospital, Middlesbrough.
S K
SK
Khan
A
A
Weusten
S
S
Bonczek
A
A
Tate
A
A
Port
D000368:Aged; D002985:Clinical Protocols; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D006113:United Kingdom