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Hip fracture in adults [QS16]

Measuring the use of this guidance

Statement: 1

Adults with hip fracture are cared for within a Hip Fracture Programme at every stage of the care pathway.

Quality standard measure: Proportion of presentations of hip fracture in which the person receives an orthogeriatric assessment prior to surgery.
What was measured: Proportion of patients who received perioperative orthogeriatric assessment.
Data collection end: December 2015
88%
Data collection end: December 2016
88.7%
Data collection end: December 2017
88.8%
Data collection end: December 2018
89.6%
Area covered: National
Source: Royal College of Physicians. National Hip Fracture Database.


Statement: 2

Adults with hip fracture have surgery on a planned trauma list on the day of, or the day after, admission.

Quality standard measure: Mortality for people having hip fracture surgery.
What was measured: 30 day mortality following cemented or uncemented hemiarthroplasty procedure.
Data collection end: April 2017
9.5%
Number that met the criteria: 39 / 412
Area covered: Local
Source: Grammatopoulos G, Wilson H A, Kendrick B J. L, Pulford E C, Lippett J, Deakin M, Andrade A J, and Kambouroglou G. (2015). Hemiarthroplasty using cemented or uncemented stems of proven design: A comparative study. Bone and Joint Journal, 97-B, pp.94-99.

Quality standard measure: Mortality for people having hip fracture surgery.
What was measured: 30 day mortality following cemented hemiarthroplasty procedure.
Data collection end: April 2017
8.6%
Number that met the criteria: 25 / 292
Area covered: Local
Source: Grammatopoulos G, Wilson H A, Kendrick B J. L, Pulford E C, Lippett J, Deakin M, Andrade A J, and Kambouroglou G. (2015). Hemiarthroplasty using cemented or uncemented stems of proven design: A comparative study. Bone and Joint Journal, 97-B, pp.94-99.

Quality standard measure: Mortality for people having hip fracture surgery.
What was measured: 30 day mortality following uncemented hemiarthroplasty procedure.
Data collection end: April 2017
11.7%
Number that met the criteria: 14 / 120
Area covered: Local
Source: Grammatopoulos G, Wilson H A, Kendrick B J. L, Pulford E C, Lippett J, Deakin M, Andrade A J, and Kambouroglou G. (2015). Hemiarthroplasty using cemented or uncemented stems of proven design: A comparative study. Bone and Joint Journal, 97-B, pp.94-99.

Quality standard measure: Mortality for people having hip fracture surgery.
What was measured: 365 day mortality following cemented or uncemented hemiarthroplasty procedure.
Data collection end: April 2017
26.2%
Number that met the criteria: 108 / 412
Area covered: Local
Source: Grammatopoulos G, Wilson H A, Kendrick B J. L, Pulford E C, Lippett J, Deakin M, Andrade A J, and Kambouroglou G. (2015). Hemiarthroplasty using cemented or uncemented stems of proven design: A comparative study. Bone and Joint Journal, 97-B, pp.94-99.

Quality standard measure: Mortality for people having hip fracture surgery.
What was measured: 365 day mortality following cemented hemiarthroplasty procedure.
Data collection end: April 2017
25%
Number that met the criteria: 73 / 292
Area covered: Local
Source: Grammatopoulos G, Wilson H A, Kendrick B J. L, Pulford E C, Lippett J, Deakin M, Andrade A J, and Kambouroglou G. (2015). Hemiarthroplasty using cemented or uncemented stems of proven design: A comparative study. Bone and Joint Journal, 97-B, pp.94-99.

Quality standard measure: Mortality for people having hip fracture surgery.
What was measured: 365 day mortality following uncemented hemiarthroplasty procedure.
Data collection end: April 2017
29.2%
Number that met the criteria: 35 / 120
Area covered: Local
Source: Grammatopoulos G, Wilson H A, Kendrick B J. L, Pulford E C, Lippett J, Deakin M, Andrade A J, and Kambouroglou G. (2015). Hemiarthroplasty using cemented or uncemented stems of proven design: A comparative study. Bone and Joint Journal, 97-B, pp.94-99.

Quality standard measure: Proportion of operations for hip fracture that are performed on the day of, or the day after, admission.
What was measured: Proportion of people with hip fracture who receive surgery on the day of, or the day after, admission.
Data collection end: December 2014
72.1%
Data collection end: December 2015
71.5%
Data collection end: December 2016
70.6%
Data collection end: December 2017
69.4%
Data collection end: December 2018
70.1%
Area covered: National
Source: Royal College of Physicians. National Hip Fracture Database.


Statement: 3

Adults with displaced intracapsular hip fracture have a total hip replacement if clinically eligible, rather than hemiarthroplasty.

Quality standard measure: People with displaced intracapsular fractures treated with total hip replacement if clinically eligible.
What was measured: People with displaced intracapsular fractures treated with total hip replacement if clinically eligible.
Data collection end: March 2014
26.1%
Data collection end: December 2016
30.4%
Data collection end: December 2017
31.4%
Data collection end: December 2018
33.5%
Area covered: National
Source: Royal College of Physicians. National Hip Fracture Database.


Statement: 4

Adults with trochanteric fractures above and including the lesser trochanter receive extramedullary implants.

Quality standard measure: Proportion of presentations of trochanteric fractures above and including the lesser trochanter in which the person receives extramedullary implants.
What was measured: People with trochanteric fractures who receive extramedullary implants such as a sliding hip screw.
Data collection end: December 2015
79.8%
Data collection end: December 2016
80.8%
Data collection end: December 2017
78.8%
Data collection end: December 2018
78.9%
Area covered: National
Source: Royal College of Physicians. National Hip Fracture Database.


Statement: 5

Adults with subtrochanteric fracture are treated with an intramedullary nail.

Quality standard measure: Proportion of presentations of subtrochanteric fractures treated with an intramedullary nail.
What was measured: Intramedullary nails used for subtrochanteric fractures
Data collection end: December 2016
84.1%
Data collection end: December 2017
86.5%
Data collection end: December 2018
89.3%
Area covered: National
Source: Royal College of Physicians. National Hip Fracture Database.


Statement: 6

Adults with hip fracture start rehabilitation at least once a day, no later than the day after surgery.

Quality standard measure: Proportion of hip fracture operations after which the person starts rehabilitation no later than the day after surgery.
What was measured: People with hip fracture who are mobilised out of bed the day after surgery.
Data collection end: March 2014
73.3%
Area covered: England and Wales
Source: Royal College of Physicians. National Audit of Inpatient Falls audit report.

Quality standard measure: Proportion of hip fracture operations after which the person starts rehabilitation no later than the day after surgery.
What was measured: People with hip fracture who are mobilised out of bed the day after surgery.
Data collection end: December 2015
71.9%
Data collection end: December 2016
77.3%
Data collection end: December 2018
79.6%
Area covered: National
Source: Royal College of Physicians. National Hip Fracture Database.

Quality standard measure: Proportion of hip fracture operations after which the person starts rehabilitation no later than the day after surgery.
What was measured: Proportion of patients who had undergone hip surgery who were able to get out of bed by the day after their operation.
Data collection end: October 2017
68.4%
Area covered: England and Wales
Source: Royal College of Physicians. The Physiotherapy Hip Fracture Sprint Audit (PHFSA).

Quality standard measure: Proportion of hip fracture operations after which the person starts rehabilitation no later than the day after surgery.
What was measured: People with hip fracture who are mobilised out of bed the day after surgery.
Data collection end: December 2017
79%
Area covered: UK
Source: Royal College of Emergency Medicine. Fractured Neck of Femur Clinical Audit.

Quality standard measure: Length of hospital stay for people with hip fracture.
What was measured: Proportion of patients who underwent emergency surgery (CEPOD list) for proximal femur fracture where the length of hospital stay was 7 days or less.
Data collection end: July 2014
22.4%
Area covered: Local
Source: Agarwal S K; Khan A A; Solan M; Lemon M (2017). Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study (2017). Annals of the Royal College of Surgeons of England | 2017 VOL 99 PT 8 PP 641-644.

Quality standard measure: Length of hospital stay for people with hip fracture.
What was measured: Proportion of patients who underwent emergency surgery (CEPOD list) for proximal femur fracture where the length of hospital stay was between 8 and 14 (inclusive) days.
Data collection end: July 2014
36.2%
Area covered: Local
Source: Agarwal S K; Khan A A; Solan M; Lemon M (2017). Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study (2017). Annals of the Royal College of Surgeons of England | 2017 VOL 99 PT 8 PP 641-644.

Quality standard measure: Length of hospital stay for people with hip fracture.
What was measured: Proportion of patients who underwent emergency surgery (CEPOD list) for proximal femur fracture where the length of hospital stay was between 15 and 21 (inclusive) days.
Data collection end: July 2014
12.1%
Area covered: Local
Source: Agarwal S K; Khan A A; Solan M; Lemon M (2017). Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study (2017). Annals of the Royal College of Surgeons of England | 2017 VOL 99 PT 8 PP 641-644.

Quality standard measure: Length of hospital stay for people with hip fracture.
What was measured: Proportion of patients who underwent emergency surgery (CEPOD list) for proximal femur fracture where the length of hospital stay was more than 21 days.
Data collection end: July 2014
29.3%
Area covered: Local
Source: Agarwal S K; Khan A A; Solan M; Lemon M (2017). Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study (2017). Annals of the Royal College of Surgeons of England | 2017 VOL 99 PT 8 PP 641-644.

Quality standard measure: Return to the pre-hip fracture level of mobility.
What was measured: Proportion of patients recovering to their previous levels of mobility at 30 days.
Data collection end: December 2015
37%
Area covered: England
Source: NHS Digital. NHS Outcomes Framework.

Quality standard measure: Return to the pre-hip fracture level of mobility.
What was measured: Proportion of patients recovering to their previous levels of mobility at 120 days.
Data collection end: December 2016
63.9%
Area covered: England
Source: NHS Digital. NHS Outcomes Framework.

Quality standard measure: Evidence of local arrangements to ensure that people with hip fracture start rehabilitation at least once a day, no later than the day after surgery.
What was measured: Proportion of sites who are able to continue physiotherapist-led rehabilitation for all hip fracture patients every day until they achieve their rehabilitation goals (7 days a week).
Data collection end: October 2017
39%
Area covered: England and Wales
Source: Royal College of Physicians. The Physiotherapy Hip Fracture Sprint Audit (PHFSA).

Quality standard measure: Evidence of local arrangements to ensure that people with hip fracture start rehabilitation at least once a day, no later than the day after surgery.
What was measured: Proportion of patients who had undergone hip surgery who had missed a day's therapy in the first week for reasons that were at least in part related to staffing.
Data collection end: October 2017
42.7%
Area covered: England and Wales
Source: Royal College of Physicians. The Physiotherapy Hip Fracture Sprint Audit (PHFSA).

Quality standard measure: Evidence of local arrangements to ensure that people with hip fracture start rehabilitation at least once a day, no later than the day after surgery.
What was measured: Proportion of patients who had undergone hip surgery who had missed a day's therapy in the first week because appropriate equipment was not available.
Data collection end: October 2017
1.1%
Area covered: England and Wales
Source: Royal College of Physicians. The Physiotherapy Hip Fracture Sprint Audit (PHFSA).

Quality standard measure: Return to the pre-hip fracture place of residence.
What was measured: Proportion of people who had a hip fracture who were able to return to their own home or sheltered housing directly from the acute ward.
Data collection end: October 2017
48.6%
Area covered: England and Wales
Source: Royal College of Physicians. The Physiotherapy Hip Fracture Sprint Audit (PHFSA).

Quality standard measure: Return to the pre-hip fracture place of residence.
What was measured: Proportion of people who had a hip fracture who were able to return to their own home or sheltered housing.
Data collection end: October 2017
63.1%
Area covered: England and Wales
Source: Royal College of Physicians. The Physiotherapy Hip Fracture Sprint Audit (PHFSA).


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