48 * Using the National Hip Fracture Database (Nhfd) to Profile the Impact of Hip Fracture on the NHS

Johansen, Antony; Neuberger, Julia; Boulton, Chris; Williams, Andy; Plant, F; Wakeman, R.; Cromwell, David; Wilson, Helen W.; Moran, Christine A.

doi:10.1093/ageing/afu126.1

Cited by 7 publications

(7 citation statements)

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“…Hip fracture repair is the commonest emergency operation for the old and frail. At any one time 4000 patients occupy hospital beds after hip fracture, on average for 3 weeks each, an annual bed occupancy of 1.5 million days . The injury is associated with total hospital costs of over £1 billion per year, which is about 1% of the NHS budget .…”

Section: Introductionmentioning

confidence: 99%

Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database

et al. 2017

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Hip fracture is the most common reason for older patients to need emergency anaesthesia and surgery. Up to one-third of patients die in the year after hip fracture, but this view of outcome may encourage therapeutic nihilism in peri-operative decisions and discussions. We used a multicentre national dataset to examine relative and absolute mortality rates for patients presenting with hip fracture, stratified by ASA physical status. We analysed ASA physical status, dates of surgery, death and hospital discharge for 59,369 out of 64,864 patients in the 2015 National Hip Fracture Database; 3914 (6.6%) of whom died in hospital. Rates of death in hospital were 1.8% in ASA 1-2 patients compared with 16.5% in ASA 4 patients. Survival rates for ASA 4 patients on each of the first three postoperative days were: 98.8%, 99.1% and 99.1% (compared with figures of > 99.9% in ASA 1-2 patients over these days). Survival on postoperative day 6 was 99.4% for ASA 4 patients. Nearly half (48.6%) of the 1427 patients who did not have surgery died in hospital. Although technically sound, a focus on cumulative and relative risk of mortality may frame discussions in an unduly negative fashion, discouraging surgeons and anaesthetists from offering an operation, and deterring patients and their loved ones from agreeing to it. A more optimistic and pragmatic explanation that over 98% of ASA 4 patients survive both the day of surgery and the day after it, may be more appropriate.

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Section: Introductionmentioning

confidence: 99%

Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database

et al. 2017

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“…The average LOS in our hospital for proximal femur fracture patients, without major complications, decreased from 16 days in 2010 to 11 days in 2012 and 2013. In UK ( 7 ), the national reports showed a mean length of acute stay of 16.4 days in 2011 and 15.7 days in 2013, which compare favorably with the average of 19.7 days observed in 2010. Another experience in Hong-Kong ( 16 ) showed that, after CP implementation the LOS in acute hospital reduced from 12.07 days in 2006 to 8.27 days in 2007, 7.67 days in 2008, and 6.66 days in 2009.…”

Section: Discussionmentioning

confidence: 75%

“…Particular efforts by surgeons to reduce the pre-operative period contributed massively to these excellent results. In comparison, the United Kingdom National Hip Fracture Database (UKD) ( 7 ) reported that the percentage of patients, with complete data, treated within 48 h of admission and within normal working hours had risen from 80% in 2010 to 87% in 2011, 83% in 2012, and 86% in 2013 (all patients who were medically unfit on admission were excluded). Similar results were found in 2009 in Hong-Kong, with 68% of the patients with hip fractures who underwent surgery within 48 h of hospital admission; in the hospital where a CP had been implemented since 2007, this rate was 86% ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Efficiency of the Lausanne Clinical Pathway for Proximal Femoral Fractures

et al. 2015

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Purpose/Introduction: The number of hip fractures is rising, due to increases in life expectancy. In such cases, patients are at risk from post-operative complications and subsequently the average length of hospitalization may be extended. In 2011, we established a clinical pathway (CP), a specific model of care for patient-care management, to improve the clinical and economic outcomes of proximal femoral fracture management in elderly patients. The goal was to evaluate the CP using clinical, process, and financial indicators.Methods: We included all surgical patients aged 65 and over, admitted to the emergency department with a fracture of the proximal femur following a fall. Assessment parameters included three performance indicators: clinical, process, and financial. The clinical indicators were the presence or absence of acute delirium on the third post-operative day, diagnosis of nosocomial pneumonia, and the number of patients fulfilling at least 75% of their nutritional requirements at the end of the hospitalization period. The process indicator was the time interval between arrival at the emergency department and surgery. The financial indicator was based on the number of days spent in hospital.Results: From 2011 to 2013, 669 patients were included in the CP. We observed that the average length of stay in hospital decreased as soon as the CP was implemented and stabilized afterwards. The goal of 90% of patients undergoing surgery within 48 h of arrival in the emergency department was surpassed in 2013 (93.1%). Furthermore, we observed an improvement in the clinical indicators.Conclusion: The application of a CP allowed an improvement in the qualitative and quantitative efficiency of proximal femoral fracture management in elderly patients, in terms of clinical, process, and financial factors.

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“…Falls are the leading cause for emergency department (ED) presentation in adults aged 65 and above [ 1 ]. A significant proportion of these patients have dementia - around 25–34% [ 2 , 3 ] - because people with dementia (PWD) are more than twice as likely to fall and twice as likely to experience injurious falls compared to their cognitively intact peers [ 4 , 5 ]. The consequences are long-term and far-reaching; PWD are more likely to experience adverse health outcomes during their hospital stay and after discharge such as hospital readmission, institutionalisation, and mortality [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial comparing the effectiveness of tai chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: protocol for the TACIT trial (TAi ChI for people with demenTia)

et al. 2018

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BackgroundFalls are a public health issue for the older adult population and more so for people with dementia (PWD). Compared with their cognitively intact peers, PWD are at higher risk of falls and injurious falls. This randomised controlled trial aims to test the clinical and cost effectiveness of Tai Chi to improve postural balance among community-dwelling PWD and to assess the feasibility of conducting a larger definitive trial to reduce the incidence of falls among PWD.MethodsA 3-centre parallel group randomised controlled trial with embedded process evaluation. One hundred and fifty community-dwelling dyads of a person with dementia and their informal carer will be recruited and assessed at baseline and at six-month follow-up. Dyads will be randomised in a 1:1 ratio to either usual care or usual care plus a Tai Chi intervention for 20 weeks. The Tai Chi intervention will consist of weekly classes (45 min’ Tai Chi plus up to 45 min for informal discussion, with up to 10 dyads per class) and home-based exercises (20 min per day to be facilitated by the carer). Home practice of Tai Chi will be supported by the use of behaviour change techniques with the Tai Chi instructor at a home visit in week 3–4 of the intervention (action planning, coping planning, self-monitoring, and alarm clock reminder) and at the end of each class (feedback on home practice). The primary outcome is dynamic balance measured using the Timed Up and Go test, coinciding with the end of the 20-week intervention phase for participants in the Tai Chi arm. Secondary outcomes for PWD include functional balance, static balance, fear of falling, global cognitive functioning, visual-spatial cognitive functioning, quality of life, and falls. Secondary outcomes for carers include dynamic balance, static balance, quality of life, costs, and carer burden.DiscussionThis trial is the first in the UK to test the effectiveness of Tai Chi to improve balance among PWD. The trial will inform a future study that will be the first in the world to use Tai Chi in a trial to prevent falls among PWD.Trial registrationNCT02864056.

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48 * Using the National Hip Fracture Database (Nhfd) to Profile the Impact of Hip Fracture on the NHS

Cited by 7 publications

References 0 publications

Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database

Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database

Efficiency of the Lausanne Clinical Pathway for Proximal Femoral Fractures

A randomised controlled trial comparing the effectiveness of tai chi alongside usual care with usual care alone on the postural balance of community-dwelling people with dementia: protocol for the TACIT trial (TAi ChI for people with demenTia)

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