Silent slips, trips and broken hips in the under 60s: a review of the literature

This critical review of the literature regarding the recovery experiences and healthcare needs of people under 60 following a fragility hip fracture seeks to identify the associated implications for nursing practice and inform care delivery. Forty papers were included following a structured database, citation and grey literature search and filtering of results in line with specified inclusion criteria. Hip fracture is a common, serious and complex injury and an important cause of morbidity, mortality and rising healthcare costs worldwide. This review indicates that although commonly associated with the elderly, incidence and impact in the under 60s has been under-explored. Current health policy, professional and social norms almost exclusively focus on the elderly, surgical interventions and short-term outcomes, rendering the under 60s an inadvertently marginalised, relatively 'silent' sub-set of the hip fracture population. Nurses must be aware, however, of the different recovery needs of this younger group. The limited evidence available indicates these include work related needs and long term physical and psychosocial limitations in this socially and economically active group. Priorities are identified for research to inform policy and practice. Meanwhile, nurses can address the needs of this group by listening to and involving them and their families as healthcare partners. [Abstract copyright: Copyright © 2018. Published by Elsevier Ltd.

Irish Hip Fracture Database summary report 2018

The Irish Hip Fracture Database (IHFD) was set up to measure the care for all patients over the age of 60 who suffer a hip fracture. There are 16 hospitals who operate on hip fracture patients. </p

Reporting national clinical audits in quality accounts

The requirement for providers of NHS services in England to produce annual Quality Accounts for the public was one component of the Next Stage Review in 2008. Introduced in 2010, apart from aiming to improve the public accountability of providers, it is anticipated that the Quality Accounts will prompt boards to engage more in considering quality, and encourage quality assessment and improvement among clinicians and managers. Our aim was to appraise one section of Quality Accounts, the reporting of national clinical audits (NCAs). A review of a random sample of 50 acute Trusts revealed that for the 94% of Trusts that provided an account of their participation in the 34 NCAs deemed eligible by the Department of Health, the overall participation rate was 69%. Rates varied between Trusts, from less than 40% to 100%. Although most Trusts did not provide examples of local quality improvement, interventions stimulated by NCAs, those that did demonstrated some innovative and effective ways of improving quality. We propose several ways in which the quality of Quality Accounts can be improved in 2011

Irish Hip Fracture Database National Report 2015

The IHFD is a clinically led, web-based audit which measures the care and outcomes of patients with hip fractures. Hip fracture care takes the patient through a complex clinical pathway involving a wide range of specialties. It is an ideal marker condition for the care of older patients in our acute hospitals and also tells us how well the trauma service is functioning. Hip fractures are an ideal condition to audit for the following reasons:• Commoncondition• Clearlydefineddiagnosis• Good evidence base for care and prevention• Care is complex and costly• Care, outcomes and costs vary• Numbers rising• High morbidity, mortality and loss of independence• 3,591 hip fractures in Ireland in 2015 (aged 60 years and over anddueto injury)This third IHFD report details 2,962 hip fracture cases in patients aged 60 years and over, discharged by 16 hospitals in 2015, which accounts for 81% of all hip fracture cases nationally.Nationally, the Model of Care for Trauma and Orthopaedic surgery2 declared the IHFD an integral part of driving clinical and organisational improvements in quality and effectiveness of care after a hip fracture. Measurement of hip fracture outcome is essential and should be recorded by all hospitals as part of a national hip fracture database.The National Healthcare Quality Report system second Annual Report3, published by the Department of Health details, key performance indicators about a number of conditions. The Hse Key Performance Indicator (KPI) for hip fracture surgery reports on the percentage of emergency hip fracture surgeries with the principal procedure carried out on days 0, 1 or 2 of the stay with a specified target of 95%. There can be many reasons for delays in performing hip fracture surgery, for example, the patient being too sick for surgery, but it can also be due to avoidable administrative reasons. Therefore, an indicator on time to hip fracture surgery is used internationally as a measure of quality.International evidence has shown us that the synergy of care standards, audit and feedback, drive measurable improvements in hip fracture outcomes for patients.In the IHFD we base our audit on six standards of care, as published by the british Orthopaedic Association and british geriatric society, in the ”blue book”; “The Care of Patients With Fragility Fracture”</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

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

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