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Surgeon describes lessons learned from UK hip fracture database
The registry allows tracking time spent per case and all processes to help improve the transparency of hip fracture care practices.
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Data from a hip fracture registry have allowed surgeons in the United Kingdom to improve the standard of care and reach a consensus on some issues of debate in the field, according to a noted orthopaedic traumatologist.
“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 at the Orthopaedic Trauma Association 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,” he said.
Practices made public
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, Moran noted. More than 60,000 patients per year are registered, and annual reports and public access to the data help to improve care through transparency of hip fracture care practices. Hospitals are named in the registry, but surgeons’ 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 orthopaedic 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 for each hospital to have patients with hip fractures 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, he said “massive variation” still exists about how to surgically treat undisplaced intercapsular fractures and the best form of anesthesia to use. – by Renee Blisard Buddle
- Reference:
- Moran CG. Symposium 1: Improving hip fracture care. Presented at: Orthopaedic Trauma Association Meeting; Oct. 3-6, 2012; Minneapolis.
- For more information:
- Christopher G. Moran, MD, FRCS(Ed), can be reached at 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.