Irish Hip Fracture DatabaseDr. Emer Ahern

Forever Autumn Community of Practice Falls Conference Cappagh, 2015

Why Audit (IHFD)?

Hip fracture management takes a frail patient through a complex clinical pathway involving a wide range of specialists, clinical teams, departments etcIdeal marker condition with which to examine the quality and outcome of the care offered to frail and older patients

Clearly defined diagnosisGood evidence base for care and preventionCare is complex and costly Care, outcomes and costs vary Numbers rising 3,428 hip fractures in 2014 at an estimated cost of 45 million

NHFD Trend data: 2008-2011

Timeline of the IHFD

Key progress to date •All 16 orthopaedic trauma units are recording data•Completeness of data fields & coverage has increased•Reduced length of stay by 2 days•Annual Irish Hip Fracture meetings

•Monthly teleconferences for the data collectors•Web publication of IHFD handbook •Annual review of the dataset•Monthly and annual hospital reports

•IHFD eNews•National Integrated Care Pathway•PubMed•Internationally…

PubMed

• The ultimate goal of the IHFD is completely aligned to the goal of the ANZHFR…provides us with a goal to aim for within the next few years…

Preliminary Report: 843 cases

8 hospitals

1st National Report 2013: 1950 cases

12 hospitals

2nd National Report 2014: 2664 (3,428) cases

14 hospitals2014

IHFD Report 2014Casemix

(N=2,664)

Gender (N=2,664)

Age group

Source of admission (N=2,664)

AMT score (n=287)

ASA grade (n= 2,221)

Pre-fracture mobility (n=2,092)

IHFD Report 2014Care processes

Mode of admission to operating hospital (N=2,664)

Admission to orthopaedic ward (N=2,664)

Surgery performed (N=2,664)

Time to surgery (n=2,532)

Cumulative time to surgery

NHQRS

NHQRS

• The in-hospital waiting time for hip fracture surgery indicator is defined as the proportion of patients aged 65 years and over with a hip fracture who have surgery within 2 days of admission ie on the day of admission, 1 day after admission or 2 days after admission in a specified year

• Published monthly in the HSE National Performance Assurance Report

• 95% of emergency hip fracture surgeries to be carried out within 48 hours of admission

• The proportion of patients with a hip fracture undergoing surgery within two days increased slightly over the ten year period from 2004 to 2013, with 82.4% of cases in 2013 undergoing surgery within two days compared to 78.8% in 2004.

• The corresponding IHFD proportion for 2013 is 74%

Reason for delay

Routine pre-op assessment by a Geriatrician (N=2,664)

Type of fracture (N=2,664)

Type of anaesthesia (n=2,532)

Type of surgery (n=2,532)

IHFD Report 2014Outcomes

Pressure ulcers (n=2,552)

Bone health assessment (n=2,552)

Falls assessment (n=2,552)

Discharge destination (n=2,664)

Length of stay (n=2,664)

Both the mean and median lengths of stay reduced during this period from 21 days to 19 days and from 14 days to 12.5 days respectively

Re-operation within 30 days (n=2,532)

Additional fields

• 89.5% Low energy traumao 20.5% had history of fragility fractureso 67.7% had no history of fragility fractureso 11.8% unknown Consultant Geriatrician 62.5% Consultant Surgeon 52.5% Consultant Anaesthetist 66.4%

IHFD Prelim reportN=843

%

IHFD 2013N=1,950

%

IHFD 2014N=2,664

%

NHFD2015N= 64,102

%

Admission to orthopaedic ward within 4 hours

32 23 15 46.1

Surgery within 48 hours and during normal working hours

77 72 70 72.1

Patients developing pressure ulcers

4 4 5 2.8

Pre-operative assessment by an orthogeriatrician

8 11 8 85.3

Bone protection medication 41 47 42 96.1

Received a falls assessment prior to discharge

60 64 54 96.5

Mortality 4 5 4

Length of Stay 18 (13) 21 (14) 19 (12.5) 15.5

Annual Hospital Report from IHFD

Challenges…•Credibility & validity of data•Facility audits•Site visits•Routine interrogation of data and discrepancies, routine local validation of data…•Improve completeness and coverage of data•Help poorly performing units•Dedicated clinical project manager

•Support ABF