Minimum Standards for the Management of Hip Fracture in the Older Person

Aim

To improve the outcomes of patients with fractured hips requiring surgery and management in NSW.

Benefits

Reduced medical complications, reduced hospital stays and improved patient outcomes.

Summary

Minimum Standards for the Management of Hip Fracture in the Older Person LogoThe Agency for Clinical Innovation (ACI) has developed the Minimum Standards for the management of hip fractures to assist hospitals to identify key components of best-practice management to support optimal patient care across NSW.

The minimum standards are supported by comprehensive data analysis and will be promoted widely when complete.

NSW Health has long recognised the issues for hip fracture patients. ACI in 2010 released the Orthogeriatric Model of Care: Clinical Practice Guide, which provided a practical guide to the management of frail, older orthopaedic patients. This was followed in 2011 by the CEC report Fractured Hip Surgery in the Elderly, which identified a number of key care-elements that are necessary to improve patient management and reduce 30-day mortality.

The ACI Unwarranted Clinical Variation Taskforce determined that the management of patients with hip fractures would be a priority for 2013. The Fractured Neck of Femur – Minimum Standards project is a collaborative effort by the Surgery, Anaesthesia and Critical Care Portfolio and the Primary Care and Chronic Services portfolios in ACI

The aim of the project is to improve outcomes for patients with hip fractures requiring surgery and management in NSW.  

Seven Standards have been identified to assist hospitals in the management of patients with hip fractures: 

Standard 1: Orthogeriatric clinical management of each patient

  • Orthogeriatric clinical management is a collaborative approach to care provided by orthopaedic and geriatric services for the care of older patients with orthopaedic disorders
  • All older hip-fracture patients should be managed in a collaborative model of care by an orthopaedic surgeon and geriatrician from the time of admission.

Standard 2: Optimal pain management

  • Effective pain management is a primary goal for patients with a hip fracture
  • Providing a combination of two or more analgesic medications with differing mechanisms is considered best practice in older frail patients who may not tolerate opioids. 

Standard 3: Surgery within 48 hours and in daytime hours (regardless of inter-hospital transfers)

  • Patients should be optimised for and undergo surgery no more than 48 hours after admission
  • Surgery should be conducted within standard daytime working hours, where possible.

Standard 4: Surgery is not cancelled

  • Once a planned date has been identified for repair of a hip fracture, surgery should not be cancelled, unless there are exceptional circumstances.

Standard 5: Commencement of mobilisation within 24 hours of surgery

  • Unless medically or surgically contraindicated, patients should be encouraged and supported to sit out of bed and begin mobilising within 24 hours of surgery.

Standard 6: Refracture prevention

  • All hip fracture patients should be assessed for future fracture risk and be offered treatment for osteoporosis if clinically appropriate.

Standard 7: Local ownership of data systems/processes to drive improvements in care

  • IT systems and a minimum dataset should be developed to facilitate standardised collection and analysis of data.

The Standards will be supported by a video series that will help explain the minimum standards to a clinician, manager and consumer audience.

Clinicians highlight the benefits for patients behind each Standard and will endorse each component of the minimum standards.

Background

The ACI Unwarranted Clinical Variation Taskforce determined that improving the management of patients with hip fractures should be a priority for 2013. This resulted from an awareness that outcomes varied across NSW.

The ACI worked with expert clinicians from the Aged Health Network and Surgical Services Taskforce to identify the components of best practice management for older patients undergoing hip fracture surgery in NSW hospitals.

The standards were informed by comprehensive data analysis and earlier work including:

  • The Clinical Excellence Commission Patient Safety Report, Fractured Hip Surgery in the Elderly released in 2011, which identified key care-elements that are necessary to improve patient management and reduce 30-day mortality.
  • The ACI Aged Health Network Orthogeriatric Model of Care: Clinical Practice Guide released in 2010, which provides a practical guide to the management of frail, older orthopaedic patients. 

Partnerships

Key Dates

Pilot Sites

This project will eventually incorporate all 37 hospitals that operate on patients with Hip Fracture.

South Western Sydney Local Health DistrictLiverpool HospitalLiverpool Hospital has been identified as the initial hospital to test the minimum standards.

Implementation Sites

Evaluation

The project will be supported by a formative evaluation and economic appraisal, and is a collaborative initiative that involves a number of ACI networks and the ACI Communications Team.

Related Initiatives

Contact

Gavin Meredith
Surgical Services Taskforce Manager
gavin.meredith@health.nsw.gov.au
02 9464 4644

Donald MacLellan
Director, Surgery, Anaesthesia and Critical Care
donald.maclellan@health.nsw.gov.au
02 9464 4604

Page Top | Added: 5 November 2013 | Last modified: 7 April 2015

ACI
Status:
Contact:
Gavin Meredith
Surgical Services Taskforce Manager
Email
02 9464 4644
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