fracture neck of femur - audit

Mobilisation after Fracture

Neck of Femur

Pradeep Chockalingam

Senior Physiotherapist

www.scribd.com/cpradheep

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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)



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)



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?



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).



What are the standards?

Day of 1st Mobilisation

Information given to the patients




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)




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%



Reason for delay

Week end : 4 (Mainly affected were

who had surgery on Thursday/Friday)

Medical reasons : 4



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.



Information given to the

patients

Educational hand outs issued : 0% (0/22),

(Data missing-2).



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).



Limitations

Approx. 11.82% of the records only

analysed in this audit.



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



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



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



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



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



Thank you

Pradeep Chockalingam



fracture neck of femur - audit

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