Lessons learnt from a decade of the Irish Hip Fracture Database

Over the last decade the Irish Hip Fracture Database (IHFD)has emerged as a central independent driving force for better patient care in Ireland. Since its inception, it has collected data on >25,000 hip fracture patients and measured care against explicit national standards. The IHFD has been instrumental in developing an Orthogeriatric service in Ireland and is a key partner in there configuration of trauma services in Ireland. Tangible benefits have been seen since the establishment of the IHFD with more patients operated on in a timely manner, assessed by a Geriatrician and mobilised early post operatively. Moving forward, the IHFD will develop care bundles to streamline the patient journey from pre-hospital to rehabilitation, with more community integration and early supported discharge. As Ireland’s trauma system continues to evolve, the IHFD is in prime position to monitor the impact of the reconfiguration of services on patient care, governance and outcomes

Improving hip fracture care in Ireland: a preliminary report of the Irish Hip Fracture Database

Introduction: Hip fractures are common injuries in the older persons, with significant associated morbidity and mortality. The Irish Hip Fracture Database (IHFD) was implemented to monitor standards of care against international standards. Methods: The IHFD is a clinically led web-based audit. We summarize the data collected on hip fractures from April 2012 to March 2013 from 8 centres. Results: There were 843 patients with the majority being (70%) female. The 80-89-year age group accounted for the majority of fractures (44%). Most (71%) sustained a fall at home. Intertrochanteric fractures (40%) were most common. Only 28% were admitted to an orthopaedic ward within 4 hours. The majority (97%) underwent surgery with 44% having surgery within 36 hours. Medical optimization (35%) and lack of theatre space (26%) accounted for most of the surgical delay. While 29% were discharged home, 33% were discharged to a nursing home or other long-stay facilities. There was a 4% in-hospital mortality rate.Conclusions: Several key areas in both the database and aspects of patient care needing improvement have been highlighted. The implementation of similar databases has led to improved hip fracture care in other countries and we believe this can be replicated in Ireland.</div

Trends in hip fracture care in the Republic of Ireland from 2013 to 2018: results from the Irish Hip Fracture Database

Hip fractures continue to be one of the most serious and costly injuries suffered by older people globally. This paper describes the development of a national hip fracture audit and summarises the first 6 years of data from the Republic of Ireland. This can help inform care, standards and outcomes of hip fracture patients.Introduction: Ireland has one of the highest standardised rates of hip fracture in the world behind northern European countries. The Irish Hip Fracture Database (IHFD) was established in 2012 to drive clinical and organisational improvements in quality and effectiveness of hip fracture care. This paper describes the progression of the IHFD between 2013 and 2018 and identifies trends and areas for improvement.Methods: The IHFD is a clinically led, web-based audit, with data collected through the national Hospital Inpatient Enquiry (HIPE) electronic system, the principal source of information from publicly funded acute hospitals in Ireland. Eligible cases are aged ≥ 60 years with hip fracture as defined by IHFD or with other specified hip fracture excluding periprosthetic fractures. As of 2015, all 16 trauma-receiving hospitals within Ireland submitted data. Demographics and adherence to six national quality standards are described.Results: A total of 17,983 cases were included in the analysis. National coverage has increased from 63% in 2013 to 99% in 2018. Demographic characteristics are unchanged, but higher levels of comorbidity are seen. Internal fixation and hemiarthroplasty are the most common modes of surgical repair with two-thirds of cases receiving spinal rather than general anaesthesia. Increasingly patients are being assessed by a geriatrician (11% in 2013 to 69% in 2018) and receive a bone health assessment (65% in 2013 to 84% in 2018).Conclusion: While some hip fracture standards have improved, further improvements are required to compare favourably internationally. Reduction of surgical delay and ensuring early mobilisation post-operatively are immediate priorities for the IHFD.</div

Impact of COVID-19 on hip fracture care in Ireland: findings from the Irish Hip Fracture Database

Purpose: To describe the impact of COVID-19 on hip fracture care during the first 6 months of the pandemic.Methods: A secondary analysis of 4385 cases in the Irish Hip Fracture Database from 1st June 2019 to 31st August 2020 was conducted.Results: Hip fracture admissions decreased by 15% during the study period (p Conclusion: Healthcare services were widely restructured during the pandemic, which had implications for hip fracture patients. There was a notable change in compliance with the IHFS. Multidisciplinary teams involved in hip fracture care should be preserved throughout any subsequent waves of the pandemic.</div

Irish Hip Fracture Database National Report 2017

This report is testament to the commitment of all the participating hospitals to the Irish Hip Fracture Database (IHFD) and the focus on providing hip fracture patients with care that is aligned to international best practice standards. The report also highlights the continuing variability in all standards at hospital level. The IHFD allows hospitals and hospital groups to measure their care at hospital, inter-hospital and national levels. This year, the 2017 IHFD report marks a departure from the Blue Book Standards (British Orthopaedic Association, 2007). As the IHFD has evolved, so too has the way we measure our hip fracture care in Ireland. From now on, the standards of care will be known as the Irish Hip Fracture Standards (IHFS) as determined by the Irish Hip Fracture Database Governance Committee.</div

Irish Hip Fracture Database National Report 2016

This fourth IHFD report details 3,159 hip fracture cases in patients aged 60 years and over, discharged by 16 hospitals in 2016, which accounts for 86% of all hip fracture cases nationally*.This will be the first report to compare individual hospital performances across six clinical care standards.Since its inception in 2012 and with more than 10,000 patient records on the database, the IHFD is now a powerful resource.The IHFD has a clear focus on driving improvements in patient care and data quality.As a maturing database, its remit has naturally broadened and the ability of the database to influence other areas has also grown e.g. national service re-design, research etc.Improvements include:• All sixteen eligible hospitals in the Republic of Ireland are now recording data.• National service re-design e.g. trauma bypass for hip fractures.• Increase in percentage of patients admitted to an orthopaedic ward within 4 hours.• Increase in percentage of patients having surgery within 48 hours (75%).• 77% of patients were mobilised on the day of or day after surgery.• Increase in percentage of patients seen by a Geriatrician (56%).• More patients received a bone health (57%) and falls (54%) assessment to prevent further fallsand fractures.• Median length of stay has reduced to 12 days.• Coverage of hip fracture cases has increased to 86%.• Completeness of data has increased to 98%.• In 2018, a new KPI for hip fractures will be tested which will measure the percentage ofpatients with hip fractures who have surgery within 48 hours from time of first presentation.This KPI will use IHFD data as its source.The IHFD was invited to participate in a comparison of eight hip fracture registers from around the world. The paper was published in ‘Injury’ (Johansen et al., 2017). This collaboration across nations further strengthens the focus and power of such registries to drive better, safer care for hip fracture patients.</div

Irish Hip Fracture Database National Report 2017-2021: improvement over time

This is the ninth national report from the Irish Hip Fracture Database (IHFD). To date, the audit has captured data on more than 28,000 patients. The Irish Hip Fracture Database National Report 2021 includes data from 3,806 cases. The data provide detailed information about the care, processes and outcomes of patients and allow each hospital to be benchmarked against comparable hospitals in Ireland and internationally. This report is the first report to explore the trends in case mix, standards and outcomes, and covers the 5-year period from 2017 to 2021.</p

Systematic review of multivariable prognostic models for outcomes at least 30 days after hip fracture finds 18 mortality models but no nonmortality models warranting validation

Objectives: Prognostic models have the potential to aid clinical decision-making after hip fracture. This systematic review aimed to identify, critically appraise, and summarize multivariable prediction models for mortality or other long-term recovery outcomes occurring at least 30 days after hip fracture. Study design and setting: MEDLINE, Embase, Scopus, Web of Science, and CINAHL databases were searched up to May 2023. Studies were included that aimed to develop multivariable models to make predictions for individuals at least 30 days after hip fracture. Risk of bias (ROB) was dual-assessed using the Prediction model Risk Of Bias ASsessment Tool. Study and model details were extracted and summarized. Results: From 5571 records, 80 eligible studies were identified. They predicted mortality in n = 55 studies/81 models and nonmortality outcomes (mobility, function, residence, medical, and surgical complications) in n = 30 studies/45 models. Most (n = 46; 58%) studies were published since 2020. A quarter of studies (n = 19; 24%) reported using 'machine-learning methods', while the remainder used logistic regression (n = 54; 68%) and other statistical methods (n = 11; 14%) to build models. Overall, 15 studies (19%) presented 18 low ROB models, all predicting mortality. Common concerns were sample size, missing data handling, inadequate internal validation, and calibration assessment. Many studies with nonmortality outcomes (n = 11; 37%) had clear data complexities that were not correctly modeled. Conclusion: This review has comprehensively summarized and appraised multivariable prediction models for long-term outcomes after hip fracture. Only 15 studies of 55 predicting mortality were rated as low ROB, warranting further development of their models. All studies predicting nonmortality outcomes were high or unclear ROB. Careful consideration is required for both the methods used and justification for developing further nonmortality prediction models for this clinical population.</p

Irish Hip Fracture Database National Report 2018

The Irish Hip Fracture Database (IHFD) is a clinically led, web-based audit that measures the best practice standards of care, known as the Irish Hip Fracture Standards (IHFS) (Table 2), and outcomes of patients with hip fractures. The IHFD started as a collaboration between the Irish Gerontological Society (IGS) and the Irish Institute for Trauma and Orthopaedic Surgery (IITOS). The National Office of Clinical Audit (NOCA) was established in 2012 and has a specific focus on turning clinical data into quality information through national clinical audits. Since 2013, the IHFD has been under the operational governance of NOCA

Irish Hip Fracture Database National Report 2019: stay safe and active at home

This report has reinforced the positive benefit that the IHFD and clinical audit is making in the healthcare system on a local, public, national and system level. The improvement in the IHFS has again reassured the system that the standards being measured are meaningful and lead to improved patient outcomes, with more patients going directly home and having improved function at discharge, and fewer patients being newly admitted into long-term care. The buy-in and enthusiasm of healthcare staff and hospital management towards the audit throughout 2019 by supporting the Foundation Programme for Quality Improvement has reinvigorated the audit and raised its priority within the healthcare system. The level of buy-in is also evident because of the use of the data by key groups, such as the HSE, National Office for Trauma Services, Business Intelligence Unit, and HSE for the hip fracture key performance indicator, and the Quality Improvement Team, HSE, as well as in some high-profile publications. Chapter 8 highlights the great work that has led to many of the audit’s recommendations coming to fruition. Thanks to the clinical leadership of our hospital clinical leads, the multidisciplinary team, and the data collection and dedication of our audit coordinators, this audit is leading the way for many other national clinical audits. A special thanks also to Dr Philip Crowley and the HSE National QIT for all of their support and for working so closely with the IHFD to develop the first Foundation Quality Improvement programme for a clinical audit. The next steps for the IHFD will include the implementation of a new IHFS for early mobilisation, delivering high-quality multidisciplinary research, and further improving on the great progress made throughout 2019.</p