People with hip fractures should be treated earlier
Patients with broken hips should be treated earlier and have surgery on the same day or the day after being admitted to hospital, says NICE.
Currently, some patients have to wait several days before receiving surgery, during which time they can be left in pain and may suffer complications.
In its first clinical guideline on hip fracture, NICE recommends that early surgery can help speed up recovery time for patients, lower the number of follow-up procedures necessary, and reduce the length of hospital stays.
Furthermore, the recommendations will cost little to put into practice and will save money in the long-term. Currently, 70-75,000 hip fractures occur each year in the UK, at a cost of £2billion.
There can be poor outcomes for people with hip fractures, as about a third die within 12 months. Most deaths are not due to the fracture itself, but result from other complications or conditions already present in the patient.
Hip fractures can occur at any stage in life, but are more common among older people. Due to an ageing population, the number of hip fractures each year is expected to rise.
The guidelines state that hip fracture operations should be carried out promptly - on the first day or the day after the patient is admitted to hospital. The surgery should be scheduled on a planned trauma list, and consultants or senior staff should supervise trainee or junior staff carrying out the procedures.
Falls and hip fractures are often a sign of other pre-existing conditions. Consequently, NICE also recommends multidisciplinary care in the form of a ward-based Hip Fracture Programme from admission through to discharge.
The programme consists of a range of healthcare professionals - including surgeons, anaesthetists, nurses and physiotherapists - working together to offer the best care and to return patients quickly to their place of stay before the injury.
NICE additionally recommends that patients should be assessed for pain immediately upon presenting at hospital, and within 30 minutes of having received pain relief.
Following this, pain should continue to be assessed hourly until the patient is settled on the ward, and regularly as part of nursing observations throughout hospital stay.
Professor Cameron Swift, Emeritus Professor of Health Care of the Elderly at Kings College London, who chaired the Guideline Development Group, said: “Hip fractures are devastating, costly and increasing with an ageing population. The consequences for patients and the health service are far worse if hip fracture management is delayed and disjointed.
“This evidence-based NICE guideline charts the way forward by recommending cost effective changes to what happens in acute hospitals. Our guideline recommends prompt surgery, and a coordinated individual hip fracture programme for each patient from the moment they arrive at hospital through to rehabilitation and discharge.
“Patients, mostly elderly people, deserve no less, and everyone potentially benefits.”
Tim Chesser, a consultant orthopaedic and trauma surgeon at North Bristol NHS Trust, who was also involved in the guidance, said that he had seen a “dramatic drop in mortality and quicker return to pre-injury health” by implementing the recommendations.
“Prompt planned surgery by an experienced team can lead to better outcomes for the patient, so this guideline is a real opportunity to spread good practice by recommending that appropriate surgery by an experienced consultant takes place the same day, or day after, a patient is admitted to hospital,” he said
Michelle Mitchell, Charity Director at Age UK, added: “Worryingly, patients can face unnecessary delays in receiving surgery, which can have very serious consequences. Every hospital must ensure all patients get treatment quickly enough to give them the best chance of a full recovery.
“It's imperative NICE guidelines are implemented throughout the country to raise standards of care for people suffering hip fractures and avoid the devastating effects of poor treatment.”
To help put this guidance into practice, NICE has produced a range of support tools including a costing report that looks at the impact of the recommendations on the NHS.
These tools feature Implementation advice - a tool that offers practical suggestions for those responsible for planning and implementing the recommended Hip Fracture Programme. The tool is aimed at relevant healthcare professionals, associated operational management and commissioners.
22 June 2011