title: The best practice tariff and hip fractures: How can Northern Ireland keep up?
abstract: BACKGROUND
  Current hip fractures guidelines recommend surgery within 36 h of admission. The 2011 National Hip Fracture Database (NHFD) report shows our institute has the fewest patients meeting this target (9%). Northern Irelands' exclusion from the "Best Practice Tariff" means no incentive-led treatment or prioritisation of hip fracture patients.
  
  
  METHODS
  We performed a systematic review of post-operative results to highlight deficiencies in delivery of patient care. We reviewed 702 patients admitted between September 2009 and April 2012. Patients were prospectively identified and added to our Fracture Outcome and Research Database (FORD). Results were compared to national average values from the NHFD.
  
  
  RESULTS
  16.7% of patients met the 36-h target to theatre compared to the UK average of 66%. 81.7% underwent a pre-operative orthogeriatric review. The main reasons for surgical delay were inadequate theatre space (58%) and medically unfit patients (29%). After exclusion of medically unfit patients, medically fit patients were divided into delayed surgery and not delayed categories. Medically fit patients who had delayed surgery had inferior outcomes- longer hospital stay and higher mortality as an inpatient and at 30 days.
  
  
  CONCLUSIONS
  Without a change in funding, Northern Ireland will struggle to compete with the UK mainland and decrease mortality in this patient group.
authors.affiliation: CT2 Surgery, Altnagelvin Area Hospital, Glenshane Road, Northern Ireland BT47 6SB, UK. Electronic address: l.murphy27@hotmail.com.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Murphy
authors.affiliation: SpR Trauma and Orthopaedics, Musgrave Park Hospital, BT9 7JB Northern Ireland, UK.
authors.forename: Sean M
authors.initials: SM
authors.lastname: McKenna
authors.affiliation: Ulster Hospital Dundonlad, Upper Newtownards Road, Belfast, Co Down BT16 1RH, UK.
authors.forename: Denise
authors.initials: D
authors.lastname: Shirley
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D005592:Fracture Fixation; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D009660:Northern Ireland / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*
keywords: Best practice tariff; Hip fracture; Northern Ireland; Trauma