Hip fracture recovery varies widely across NHS hospitals

Hip fracture recovery varies widely across NHS hospitals
© iStock/fotostorm

Research has found that hip fracture recovery varies between NHS hospitals in England and Wales, and in some hospitals, one in ten patients die within one month.

Hip fractures are cracks or breaks in the femur close to the hip joint. They are typically caused by a fall or injury, which are common amongst older people who may have reduced vision, mobility and balance problems. Patients with a suspected hip fracture receive surgery at the hospital. Now, researchers from the University of Bristol have illuminated that across NHS hospitals, hip fracture recovery fluctuates.

The researchers explored new ways NHS hospitals can improve hip fracture recovery through medical care, and the results will be used in a toolkit.

NHS hospital care for hip fractures

The researchers used anonymous, routinely collected hospital records from 178,757 older adults in England and Wales who had a hip fracture between 2016 and 2019. They wanted to discover how hospital care may affect a patient’s chance of survival, how long patients needed to stay in the hospital, and how often patients were re-admitted to the hospital due to complications.

The team found hip fracture recovery differed vastly between the 172 hospitals in the study across England and Wales. It was recorded that one in ten patients died within a month of their fracture, whilst in other hospitals, the figure was much less.

The researchers also found that time spent in hospitals varied. In some hospitals, people with hip fractures stayed on average around 12 days; in other hospitals, this was over a month. The chance of patients returning to the hospital after going home varied massively too. Moreover, in some hospitals in the study, the risk was low – about four in 100 people but in high-risk hospitals, around 30 in 100 people were re-admitted to the hospital.

Celia Gregson, Professor in Clinical Epidemiology in the Musculoskeletal Research Unit at the University of Bristol and chief investigator of the study, said: “Patients should be able to expect to receive the same, high-quality care if they break their hip, irrespective of where they live or which hospital they attend.

“The results of our study have shown multiple, important points in the pathway of patient care which hospitals can focus on to streamline and improve the quality of their hip fracture services and patient outcomes.”

The worrying state of care for hip fracture recovery

In hospitals where staff could get around 90% of their hip fracture patients out of bed promptly the day after surgery, patients stayed in the hospital two days less on average in hospitals that did not manage to mobilise their patients well.

Professor Antony Johansen, Clinical Lead for the National Hip Fracture Database and an author of the study, added: “It’s vital that hospitals have enough staff – nurses and physiotherapists – so they can help patients get back on their feet quickly after a hip fracture otherwise patients will lose their independence, and may even lose the will to recover.”

The researchers identified patients with a lower risk of dying in hospitals where hip fracture recovery staff met regularly at monthly clinical governance meetings to discuss feedback from patients.

It is estimated that 890 excess readmissions may be avoided yearly in England and Wales if all hospitals understood delays between discharge and initiation of community therapy, as this knowledge would contribute to reducing risk when planning discharge. Overall, the team found 41 different ways hospitals deliver hip fracture recovery care and how they were linked to patient outcomes.

This is the first paper to be published from the REDUCE Study (REducing unwarranted variation in the Delivery of high-qUality hip fraCture services in England and Wales). This research will provide vital information for a new ‘toolkit’ designed for hospital managers and senior doctors. Each ‘tool’ will address different aspects of the care pathway for hip fracture recovery.


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