Article Text
PDF
Abstract
Aims and Objectives Hip fracture is the commonest fracture in older people. Multiple RCEM national audits on this group have demonstrated a wide variation in the standard of care.
RCEM collaborated on hip fracture care with Public Health Scotland and national clinical audits in the UK and Ireland in 2023.1 The objective was to drive quality improvement.
In 2021 the National Hip Fracture Database (NHFD) introduced a new key performance indicator (KPI 0) focused on ED care; measuring a combination of the proportion of patients who both received a Fascia Iliac Block (FIB) and were admitted to an appropriate ward within four hours.
We set out to review the 2023 NHFD data, to ascertain whether there has been any improvement in ED administration of pain relief.
Method and Design All acute hospitals in England, Wales and Northern Ireland upload data on every patient presenting with a hip fracture to the NHFD.
We used data on all 2023 patients to calculate the proportion of ED patients who received an FIB in each hospital.
Results and Conclusion 168 acute hospitals entered data on 72,993 hip fracture patients. After exclusion of people who fell as inpatients, 70,802 of these (97%) were admitted via ED.
Two-thirds (69%) received a pre-operative FIB, and nearly all (96.5%) received this in the ED. The FIB was performed by ambulance staff in 0.6% of cases, and on the trauma ward in the remaining 2.6%.
The reason for a block not being performed was recorded as a local (15%) or systemic contraindication (52%) or patient refusal (33%).
This compares favourably with previous data from RCEM[1] and the NHFD (figure 1). Despite the deterioration in many ED metrics, there has been a substantial improvement in the proportion of ED hip fracture patients receiving pain relief.
Reference