Release of the UK National Hip Fracture Database (NHFD) report 2022

The National Hip Fracture Database monitors and provides guidance for the improvement of care in older patients admitted to hospital with fragility fractures of the femur in the UK. The latest annual report encompasses data from 2020 and 2021 and demonstrates how care compares with that prior to the COVID-19 pandemic. It builds on the detailed analysis of six original Key Performance Indicators (KPIs) that track care through the hospital care. It also seeks to look forward with innovations including new KPIs designed to examine the very first and final stages of each patient’s care pathway by adding in an indicator on the use of nerve blocks to manage pain before surgery and ensuring access to ongoing bone strengthening up to 120 days post-surgery. It also highlights the evolution of care in injuries throughout the femur.

Key recommendations from the report are based on specific indicators and include: 

• Improve initial care: Hip fracture teams should use indicator as a marker of initial care and a driver to improve the provision of local anaesthetic nerve blocks and fast-tracking of patients to an appropriate ward. Performance should be considered alongside the figures for their unit in the Anaesthesia run chart and Assessment benchmarking table.
• Avoid further fragility fractures: To help patients avoid further fragility fractures, hip fracture teams should review bone strengthening arrangements for 120-day follow-up.
• Minimise inequalities: Hip fracture teams should minimise inequalities in health care; specifically by reviewing whether support and information is provided in formats and languages appropriate to their patients.

Will Eardley, Surgeon and NHFD surgical clinical lead, states that the report “ provides an overview of patient management from early phases of interaction between Emergency Departments and receiving wards, through perioperative care and onward rehabilitation. We encourage the reader to reflect on the two new Key Performance Indicators enabling assessment of care at the very first and final stages of each patient’s care pathway.”

Antony Johansen, NHFD orthogeriatrician clinical lead, notes that the Audit is moving to a new era of quarterly reporting, which will allow teams to use the live data on the NHFD website to inform governance meetings and local improvement work. Dr. Johansen states that “The challenges facing health care in the UK mean that services are developing rapidly and need to be able to respond quickly to problems as they arise. The new Quarterly Governance Tool is an opportunity for team members and trainees from all disciplines to make use of the data available on the NHFD website as a driver for QI”.