Quality statement 1: Multidisciplinary management

Quality statement

Adults with hip fracture are cared for within a Hip Fracture Programme at every stage of the care pathway. [2012, updated 2016]

Rationale

People with hip fracture, including those cared for in the community, often have comorbidities and complex care needs. The multidisciplinary approach of a Hip Fracture Programme, with regular assessment and continuous rehabilitation, has been found to better meet those needs, and lead to improved functional outcomes and reduced mortality.

Quality measures

Structure

Evidence of local arrangements to ensure that people with hip fracture are cared for within a Hip Fracture Programme at every stage of the care pathway.

Data source: Local data collection.

Process

a) Proportion of presentations of hip fracture in which the person receives an orthogeriatric assessment prior to surgery.

Numerator – the number in the denominator in which the person receives an orthogeriatric assessment prior to surgery.

Denominator – the number of presentations of hip fracture.

Data source: Local data collection. The National Hip Fracture Database records access to orthogeriatric assessment.

b) Proportion of presentations of hip fracture in which the person has their goals for multidisciplinary rehabilitation identified.

Numerator – the number in the denominator in which the person has their goals for multidisciplinary rehabilitation identified.

Denominator – the number of people having surgery for hip fracture.

Data source: Local data collection.

Outcome

a) Mortality for people with hip fracture at discharge.

Data source: Local data collection.

b) Functional outcome at 1 year.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as hospitals) have systems in place to ensure that people with hip fracture are cared for within a Hip Fracture Programme at every stage of the care pathway.

Commissioners (such as clinical commissioning groups) ensure that they commission hip fracture services that provide care within a Hip Fracture Programme at every stage of the care pathway.

People with hip fracture are looked after within a programme of care, called a Hip Fracture Programme. This involves a team of healthcare professionals with different skills working together to provide care. Hip Fracture Programmes provide care at every stage, in hospital and at home, which includes regular assessment, and coordination of care and rehabilitation.

Source guidance

Hip fracture: management (2011) NICE guideline CG124, recommendation 1.8.1 (key priority for implementation)

Definitions of terms used in this quality statement

Hip Fracture Programme

A coordinated multidisciplinary approach ensuring continuity of care and responsibility across the clinical pathway. It covers care in all settings, including ambulances, A&E departments, radiology, operating theatres, wards and in the community and primary care, and at all stages, including diagnosis, treatment, recovery, discharge planning, rehabilitation, long-term after care and secondary prevention.

It involves formal 'orthogeriatric' care, with the geriatric medical team contributing to joint preoperative patient assessment, and increasingly taking the lead in postoperative medical care, multidisciplinary rehabilitation and discharge planning.

It includes all of the following:

  • orthogeriatric assessment

  • rapid optimisation of fitness for surgery

  • early identification of individual goals for multidisciplinary rehabilitation to recover mobility and independence, and to facilitate return to pre-fracture residence and long-term wellbeing

  • continued, coordinated, orthogeriatric and multidisciplinary review

  • liaison or integration with related services, particularly mental health, falls prevention, bone health, primary care and social services

  • clinical and service governance responsibility for all stages of the pathway of care and rehabilitation, including those delivered in the community.

[Adapted from NICE's guideline on hip fracture, recommendation 1.8.1 and expert consensus]