Hip fracture patients need better post-hospital care
Published: 02 Sep 2016
A new report on hip fracture surgery shows that not all patients are receiving properly planned care and rehabilitation after leaving hospital.
View full report here
Findings published in the National Hip Fracture Database (NHFD) annual report for England, Wales and Northern Ireland reveal that collaboration between orthopaedic surgeons and geriatricians in coordinated hip fracture programmes has led to improved patient care in many areas, with two thirds of all hip fracture patients receiving ‘best practice’ care in hospital.
However, the authors caution that such collaborations appear to focus on the acute care of patients with little influence over longer term rehabilitation. They express concern that a number of hospitals are still delivering care under a traditional orthopaedic-led model despite national guidelines calling for multidisciplinary partnerships.
The NHFD report evidences how access to a multidisciplinary programme of care and rehabilitation for older people after hip fracture surgery can improve patient experience, enhance their recovery and save money for the NHS by reducing length of stay in hospital and patient re-admissions.
Hip fracture is the most common serious injury for older people and the most common reason for them needing emergency surgery. Emergency hip fracture surgery costs the NHS more than £1 billion a year and length of hospital stay represents the largest portion of the cost. Patients may remain in hospital for several weeks, taking up around 1.5 million bed days each year, equating to continuous occupation of more than 4,000 NHS beds across England, Wales and Northern Ireland.
The NHFD report analyses the process and outcomes of care of nearly 65,000 people who presented with a hip fracture across 177 hospitals. It reports much good practice within inpatient care; 72% of patients received surgery on their first or second day in hospital and the same percentage were able to get out of bed by the day after their operation.
The report calls for hip fracture programmes to cover the entire pathway of care for frail older people, from hospital admission to recovery, by involving rehabilitation and community services alongside surgical, medical and nursing care in a multidisciplinary team. It recommends locally managed partnerships between clinicians and community service providers to extend all hip fracture programmes into post hospital care. The report also calls for hospital hip fracture teams to work with rehabilitation and community units to undertake a 120 day follow-up for all patients as an integral part of their care.
The report cites several examples of good practice, where cross-cutting partnerships linking hospital and community services are improving outcomes and reducing hospital bed occupation.
• Royal Berkshire Hospital, Reading – Where a new pathway includes early mobilisation and proactive discharge planning. Patients are placed under the care of specialist doctors in a dedicated specialist multi-disciplinary team providing post-operative care and rehabilitation. Patients are reporting enhanced care and average length of hospital stay has been reduced from 19.3 days to 15.2 days.
• St Peter’s Hospital, Ashford – Where the effectiveness of an early orthopaedic supportive discharge scheme has led to an overall reduction in the percentage of patients sent to rehabilitation and very positive feedback from patients.
But it also indicates there are many instances where hip fracture programmes do not include post hospital care and patients are losing out. In the report’s foreword Iona Price, who is a carer representative on the NHFD advisory group, tells the story of how her own mother’s delayed access to rehabilitation care, after she was discharged from hospital to a nursing home following hip fracture surgery, affected her recovery. She calls for frail older people to be “given timely access to the rehabilitation they need as soon as they are fit enough to undertake it, wherever they are in the community.”
Dr Antony Johansen, NHFD clinical lead, orthogeriatric medicine said:
“Collaboration between geriatricians and orthopaedic surgeons was key to NICE’s recommendation that patients are treated as part of a ‘hip fracture programme’. The NHFD has documented the success of such programmes in delivering improved hip fracture care, but many are still focused on the first hours and days of care. Patients expect high quality care throughout their recovery. Teams in acute hospitals must link with colleagues in rehabilitation and social care if hip fracture programmes are to deliver such care, and to understand how this supports their patients’ recovery”.