Surgeon describes lessons learned from UK hip fracture database

Issue: February 2013

MINNEAPOLIS — Data from the United Kingdom’s hip fracture registry has allowed surgeons there to improve the standard of care and reach a consensus on some issues of debate in the field, according to a noted orthopedic traumatologist in the country.

“You absolutely need audit data if you are going to change the world in a factual way,” Chris Moran, MD, FRCS(Ed), said during a symposium presentation at the Orthopaedic Trauma Association 2012 Annual Meeting. “Our hip fracture database has given us that. It gives us prospective data. It gives us real-time data. I know what is happening in my unit up to date by month.”

Practices made public

He noted that the registry covers 58.5 million people in Wales, Northern Ireland and England, with more than 188 hospitals signed up to submit data on the web in real-time. More than 60,000 patients per year are registered, and annual reports and public access to the data helps to improve care through transparency of hip fracture care practices. Hospitals are named in the registry, but surgeon’s names are kept private.

“This sort of stuff in the local press or in the national press has a fairly rapid reaction,” Moran said.

The registry allows anyone to see the “good and the bad” in the processes of care, he said. For example, the registry allows measurement of time from arrival in the emergency room to getting a bed in the orthopedic ward. According to Moran, 95% of patients now obtain a ward bed in this time.

“None of us would want our relatives sitting on a trolley for 4 hours in the emergency room, but it happens,” Moran said.

Areas of improvement and success

The registry also enables conformity of view, meaning each hospital can see what other centers are doing and change their practices to improve the standard of care. For example, one audit standard is that each hospital has patients with hip fracture admitted for surgery within 36 hours of presentation.

Data from the registry has also helped surgeons achieve conformity of view on controversies in the field. For example, 85% of hospitals now use sliding hip screws rather than intramedullary nails for the treatment of patients with intertrochanteric fractures and 85% of hip fracture patients throughout the country now get osteoporosis assessments for falls prevention which is a “major advance,” according to Moran. However, “massive variation” still exists about how to surgically treat undisplaced intercapsular fractures and the best form anesthesia to use, he said. – by Renee Blisard Buddle

Reference:

Moran CG. Symposium 1: Improving hip fracture care. Presented at the Orthopedic Trauma Association 2012 Meeting. Presented at: The Orthopaedic Trauma Association Annual Meeting; Oct. 3-6, 2012; Minneapolis.

For more information:

Christopher G. Moran, MD, can be reached at the Department of Trauma and Orthopaedics, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, UK; email: chris.moran@nuh.nhs.uk.
Disclosure: Moran is a board member of the British Orthopaedic Association. <