Fracture neck of Femur - Audit
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Mobilisation after Fracture
Neck of Femur
Pradeep Chockalingam
Senior Physiotherapist
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Facts & Figures
Occupies 20% of Orthopaedic beds.Parrott S (2000)
Average length of stay
20 days Parrott S (2000)
17.5 days Hamilton B , Bramley-Harker RE (1999)
Average Cost per Patient £238 x 20 Days = £ 4760 (1998/99 cost). Parrott S (2000)
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Facts & Figures @ Q.E.H.
No of Patients 219 (2003)
203 (2004)
Length of stay Mean 21.2 & Median 16 days (2003)
Mean 19.9 & Median 15 days (2004)
30 day mortality rate11.4 (2003)
13.8 (2004)
Edmonson JE (2005)
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Aim
To find out when we are mobilising the patient after surgery.
If there is any delay what's the reason.
What information we are giving to the patients?
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Procedure
Retrospective audit.
Data collected for patients above 60 years admitted between Oct 04 and Feb 05
No. of admissions during the period :70
No. records received for audit : 24 (20 full records, 4 partial records & 46 records were in various clinics).
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What are the standards?
Day of 1st Mobilisation
Information given to the patients
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Day of 1st Mobilisation
If medically stable rehab should begin within
24 hours. (S.I.G.N 2002)
Mobilise as soon as possible on first or
second day. (N.Z.G.G 2003)
By 48hrs. : if condition allows, start mobilise.(Department Protocol, QEH)
Most of the hospitals mobilised 50% of the
patients on day 2 (5/8), day 1(1/8). (Todd CJ 1995)
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Day of 1st Mobilisation
Day 1
Day 2
Day 3>
Number of patients mobilised on 1st or 2nd
post OP day : 9/17 (Data missing: 4, RIP: 3)
Number of patients mobilised on 3rd post OP
day or above : 8
29%
24%
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Reason for delay
Week end : 4 (Mainly affected were
who had surgery on Thursday/Friday)
Medical reasons : 4
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Information given to the
patients
“Let patients know in advance that they will be encouraged to move within 24 hours. Acknowledge that starting to walk again is a challenge and will be uncomfortable”.(S.I.G.N 2002)
An audit by Southern Derbyshire Acute Hospital NHS Trust (2002/3) revealed that patients were not receiving any kind of information. Now they ensure patients receive appropriate information Booklet.
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Information given to the
patients
Educational hand outs issued : 0% (0/22),
(Data missing-2).
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Suggestions/Recommendations
To produce and issue new patient
information leaflet. (as hospital withdrew
the fracture neck of femur leaflets from
the intranet)
Organising early check x-ray, especially
for patients having surgery on
Thursday.
Re-audit (Prospective).
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Limitations
Approx. 11.82% of the records only
analysed in this audit.
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References
Dept. of Orthopaedic Physiotherapy, Protocol for Physiotherapy treatment for Fracture Neck of Femur. Gateshead Health NHS Foundation Trust.
Edmonson JE. (2005). Presentation: Fractured neck of femur audit. Gateshead Health NHS Foundation Trust.
Hamilton B, Bramley-Harker RE. (1999). The Impact of the NHS Reforms on Queues and Surgical Outcomes in England: Evidence from Hip Fracture Patients. The Economic Journal. 109( 457): 437-62.
Parrott S. (2000). The Economic Cost of Hip Fracture in the UK. The University of York. website: http://www.dti.gov.uk/homesafetynetwork/pdf/hipfracture.pdf
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References
Scottish Intercollegiate Guidelines Network. (2002). Prevention and Management of Hip Fracture in Older People, A national clinical guideline. Royal college of Physicians Edinburg.
Southern Derbyshire Acute Hospitals NHS Trust. (2002/3). Theme 1 – Managing the whole pathway for trauma patients. In: Publication of the results of the extended development projects funded by Action On Orthopaedics in 2002/3. NHSModernisation Agency. website:http://www.wise.nhs.uk/sites/clinicalimprovcollab/orthopaedics/Document%20Library2/1/Action%20on%20Orthopaedics%20Development%20Project.doc
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References
New Zealand Guidelines Group. (2003). Best Practice Evidence-Based Guideline, Acute Management and Immediate Rehabilitation after Hip Fracture amongst People aged 65 years and over. New Zealand Guidelines Group. website:http://www.nzgg.org.nz/guidelines/0007/Hip_Fracture_Management_Fulltext.pdf
Todd CJ et al. (1995) Differences in mortality after fracture of hip: the East Anglian audit. BMJ. 310(April 8): 904-908
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Bibliography
Handoll HHG, Sherrington C, Parker MJ. (2004). Mobilisation strategies after hip fracture surgery in adults. The Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD001704. DOI: 10.1002/14651858.CD001704.pub2.
National Services Scotland. (2004). Scottish Hip Fracture Audit Report: National Table. National Services Scotland. website: http://www.show.scot.nhs.uk/shfa
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Dept. of Clinical Audit
Dept. of Health Records
Dept. of Orthopaedics
Dept. of Ortho. Geriatrics
Dept. of Nursing
C.O.R.T
Orthopaedics Physiotherapy Team
Thanks
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Thank you
Pradeep Chockalingam
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