Quality statement 2: Timing and expertise for surgery

Quality statement

Adults with hip fracture have surgery on a planned trauma list on the day of, or the day after, admission. [2012, updated 2016]

Rationale

People with hip fracture can experience pain and anxiety while waiting for an operation. Delays in surgery are associated with negative outcomes for mortality and return to mobility. Therefore, it is important to avoid any unnecessary delays for people who are assessed as fit for surgery. A planned trauma list includes specific healthcare professionals with the expertise required for hip surgery. Senior staff supervision can help to reduce the risk of complications during the surgery.

Quality measures

Structure

a) Evidence of local arrangements to ensure that people with hip fracture have surgery on a planned trauma list.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that people with hip fracture have surgery on the day of, or the day after, admission.

Data source: Local data collection.

Process

a) Proportion of operations for hip fracture that are performed on a planned trauma list.

Numerator – the number in the denominator that are performed on a planned trauma list.

Denominator – the number of operations for hip fracture.

Data source: Local data collection. The National Hip Fracture Database records the time of the operation in relation to the admission.

b) Proportion of operations for hip fracture that are performed on the day of, or the day after, admission.

Numerator – the number in the denominator that are performed on the day of, or the day after, admission.

Denominator – the number of operations for hip fracture.

Data source: Local data collection. The NHS Digital Compendium of Clinical and Health Indicators records emergency hospital admissions and timely surgery: fractured proximal femur. The National Hip Fracture Database records the time of the operation in relation to the admission.

Outcome

a) Postoperative complications for people with hip fracture.

Data source: Local data collection.

b) Length of hospital stay for people with hip fracture.

Data source: Local data collection.

c) Mortality for people having hip fracture surgery.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (hospitals) ensure that systems are in place for people with hip fracture to have surgery on a planned trauma list on the day of, or the day after, admission.

Healthcare professionals (such as specialists, orthogeriatricians and anaesthetists) perform hip fracture surgery on a planned trauma list on the day of, or the day after, admission.

Commissioners (such as clinical commissioning groups) ensure that they commission services that have sufficient capacity for people with hip fracture to have surgery on a planned trauma list on the day of, or the day after, admission.

People with hip fracture have an operation carried out by a team of senior specialists on the day they are admitted to hospital or the next day.

Source guidance

Hip fracture: management (2011) NICE guideline CG124, recommendations 1.2.1 (key priority for implementation) and 1.5.1

Definitions of terms used in this quality statement

Planned trauma list

A planned trauma list is one with a rostered senior anaesthetist, senior surgeon and dedicated theatre time.

[NICE's guideline on hip fracture, full guideline]