027Using Clinical Audit to Improve Hip Fracture Care in Ireland: The Irish Hip Fracture Database

Abstract

Abtract In 2016, 3,610 patients over the age of sixty were hospitalised with a hip fracture in Ireland. The acute hospital care costs are in excess of €45 million and growing. This doesn’t include the long term costs of rehabilitation, convalescence, community care and long term care. The IHFD is a clinically led, web based audit of hip fracture casemix, care and outcomes. It is supported by the Irish Gerontological Society (IGS) and the Irish Institute of Trauma and Orthopaedics (IITOS) and the National Office of Clinical Audit (NOCA) provides governance and operational support for the IHFD. All sixteen eligible hospitals in the Republic of Ireland are included. The most recent IHFD report 2015 published in 2016 is comprised of data from 2,962 hip fracture cases from 16 hospitals. The coverage of the data for 2015 was 81%. The mean length of stay was 20 days and the median length of stay was 13 days in 2015. The 2016 report will be published later this year. Preliminary data for 2016 shows the coverage has increased to 86.5%. In the 2015 National report published in 2016 70% hip fractures were female, 83% patients were admitted from home and 48% were independently mobile, 37% fractures were intracapsular displaced, 36% of arthroplasties were cemented and 30% patients were discharged directly home. Thirty-nine percent (39%) of patients were reviewed by a geriatrician at any time during their admission. The proportion of patients being reviewed pre-operatively is 15%. In 2017, the focus continues to be on improving data quality and increasing coverage nationally to 100% for all sites. To ensure all suspected hip fracture patients should be brought directly to the trauma operating hospital. Each hospital should establish a hip fracture working group to review and utilise the IHFD data locally to improve patient care.

The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery

“…In regions where this indicator is stable, they could consider extending audits to measure the extent of mobilisation on the first postoperative day and until discharge, using tools like the CAS, which was explicitly developed for in-hospital mobility monitoring in hip fracture patients. 14,23 This suggestion has been employed by both the Danish and Irish hip fracture databases 27,30 and recommended as a ‘must’ outcome measure by the American Physical Therapy Associations clinical practice guideline for physiotherapy of older adults with hip fracture. 31…”