Hip fracture patients need better follow-up

THE acute care of patients with hip fracture has improved in many areas of the UK but not all patients are receiving properly planned care and rehabilitation after leaving hospital.

These are key findings of the National Hip Fracture Database (NHFD) annual report for England, Wales and Northern Ireland.

The authors conclude that collaboration between orthopaedic surgeons and geriatricians in coordinated hip fracture programmes has led to improved patient care in many areas, with two-thirds of all hip fracture patients receiving "best practice" care in hospital. But such collaborations appear to have little influence over longer-term rehabilitation with a number of hospitals still delivering care under a traditional orthopaedic-led model despite national guidelines calling for multidisciplinary partnerships.

Nearly 65,000 cases across 177 hospitals were assessed and it was found 72 per cent of hip fracture patients received surgery on their first or second day in hospital and the same percentage were able to get out of bed by the day after their operation.

But the report calls for hip fracture programmes to cover the entire pathway of care for frail older people, from hospital admission to recovery, by involving rehabilitation and community services alongside surgical, medical and nursing care in a multidisciplinary team. It also calls for hospital hip fracture teams to work with rehabilitation and community units to undertake a 120-day follow-up for all patients as an integral part of their care.

Dr Antony Johansen, NHFD clinical lead, orthogeriatric medicine, said: "Collaboration between geriatricians and orthopaedic surgeons was key to NICE’s recommendation that patients are treated as part of a ‘hip fracture programme’. The NHFD has documented the success of such programmes in delivering improved hip fracture care, but many are still focused on the first hours and days of care.

"Patients expect high quality care throughout their recovery. Teams in acute hospitals must link with colleagues in rehabilitation and social care if hip fracture programmes are to deliver such care, and to understand how this supports their patients’ recovery".