Minimising delays for surgery following hip fracture

Minimising the delay to theatre for patients who have suffered hip fracture is a contributory factor to achieving improved patient care. The recommendations contained in SIGN Guideline 56 (Prevention and Management of Hip Fracture in Older People SIGN Publication No. 56, Scottish Intercollegiate Guidelines Network, Edinburgh 2002) state that hip fracture patients should be operated on as soon as possible (within 24 hours) and during standard daytime working hours, if their medical condition allows.

Fair To All, Personal To Each (Scottish Government, 2004) committed the NHS in Scotland to this target:
'From the end of 2007, all orthopaedic departments handling trauma cases will comply with the 24-hour surgery target for hip fracture cases, unless there are documented clinical reasons relating to the patient's condition that make this undesirable.'

In May 2006, the Scottish Government's National Hip Fracture Delivery Team confirmed the detail of the underpinning approach for the delivery of this target.  This target is subject to two important caveats. Firstly, patients should not proceed to surgery unless medically fit for the operation. Secondly, for reasons of patient safety, the operation should not be undertaken out with normal working hours unless medically indicated.

This Delivery Team recommended that the operational standard for hip fracture surgery be defined as:
'98% of all hip fracture patients are to be operated on within 24 hours of admission to an orthopaedic unit, subject to medical fitness and during safe operating hours ( 8 am -  8 pm, seven days a week).'

The Scottish Hip Fracture Audit (SHFA)  collects data about a wide range of aspects of care and outcomes of patients who have suffered hip fracture, as a basis for continuous service improvement. The SHFA includes data that enables NHS Boards' compliance with this target to be monitored. In recent years different combinations of hospital sites have participated in the SHFA and therefore a full picture of performance has not been possible. 

Since April 2007 the 11 Scottish mainland Area Health Boards have participated in the SHFA and a summary of performance since then is provided in Table 1 below. The number of 'eligible hip fractures' is those patients who were assessed as being medically fit to be operated on. Due to the nature of the collection and validation of audit data the December figures should be regarded as provisional and could change by a small amount in future publications.

NHSSCOTLAND: TIME TO SURGERY FOLLOWING HIP FRACTURE

	Admission during month ending
Indicator	Jan-08	Feb-08	Mar-08
Number of Hip Fractures	641	564	604
Number of Eligible Hip Fractures	559	487	536
Number in Surgery Within 24 Hours	548	477	522
% in Surgery Within 24 Hours	98.0	97.9	97.4

 Comparable information by NHS board is available below:

• Time to surgery following a hip fracture by NHS board (April 2007 to March 2008)