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  • Irish Hip Fracture DatabaseDr. Emer Ahern Forever Autumn Community of Practice Falls Conference Cappagh, 2015

    *

  • Why Audit (IHFD)?Hip fracture management takes a frail patient through a complex clinical pathway involving a wide range of specialists, clinical teams, departments etcIdeal marker condition with which to examine the quality and outcome of the care offered to frail and older patients

    Clearly defined diagnosisGood evidence base for care and preventionCare is complex and costly Care, outcomes and costs vary Numbers rising 3,428 hip fractures in 2014 at an estimated cost of 45 million

  • NHFD Trend data: 2008-2011

    *

  • Timeline of the IHFD

  • Key progress to date

    All 16 orthopaedic trauma units are recording dataCompleteness of data fields & coverage has increasedReduced length of stay by 2 daysAnnual Irish Hip Fracture meetings

    Monthly teleconferences for the data collectorsWeb publication of IHFD handbook Annual review of the datasetMonthly and annual hospital reports

    IHFD eNewsNational Integrated Care PathwayPubMedInternationally

  • PubMed

  • The ultimate goal of the IHFD is completely aligned to the goal of the ANZHFRprovides us with a goal to aim for within the next few years

  • Preliminary Report: 843 cases 8 hospitals1st National Report 2013: 1950 cases 12 hospitals 2nd National Report 2014: 2664 (3,428) cases 14 hospitals2014

  • IHFD Report 2014Casemix(N=2,664)

    *

  • Gender (N=2,664)

    *

  • Age group

    *

  • Source of admission (N=2,664)

    *

  • AMT score (n=287)

    *

  • ASA grade (n= 2,221)

    *

  • Pre-fracture mobility (n=2,092)

    *

  • IHFD Report 2014Care processes

    *

  • Mode of admission to operating hospital (N=2,664)

    *

  • Admission to orthopaedic ward (N=2,664)

    *

  • Surgery performed (N=2,664)

    *

  • Time to surgery (n=2,532)

    *

  • Cumulative time to surgery

    Chart1

    0

    0.0396196513

    0.118858954

    0.2377179081

    0.3961965135

    0.5150554675

    0.6735340729

    1.030110935

    1.3074484945

    1.7036450079

    2.3771790808

    3.2091917591

    4.2789223455

    5.3882725832

    7.3692551506

    9.9049128368

    12.6386687797

    15.3724247227

    18.2250396197

    22.3058637084

    25.1584786054

    28.6846275753

    32.4484944532

    36.3312202853

    39.3423137876

    42.0760697306

    44.6909667195

    47.3454833597

    48.969889065

    50.7131537242

    52.0206022187

    53.1299524564

    53.882725832

    54.4770206022

    55.4675118859

    56.0618066561

    57.0126782884

    58.0824088748

    58.9540412044

    60.1030110935

    61.0538827258

    61.9651347068

    63.3122028526

    64.6592709984

    65.8874801902

    67.6703645008

    69.294770206

    70.7210776545

    72.3454833597

    73.5736925515

    74.4057052298

    75.1584786054

    75.7131537242

    76.1093502377

    76.4659270998

    76.7828843106

    77.1394611727

    77.4564183835

    77.8129952456

    77.971473851

    78.2884310618

    78.5657686212

    79.2789223455

    79.793977813

    80.5071315372

    81.1806656101

    81.6561014263

    82.4881141046

    82.9239302694

    83.5182250396

    83.9936608558

    84.7860538827

    85.4199683043

    85.8954041204

    86.2519809826

    86.4896988906

    87.0443740095

    87.1632329635

    87.440570523

    87.5990491284

    87.6386687797

    87.9160063391

    88.1141045959

    88.470681458

    88.7083993661

    88.9461172742

    89.1045958796

    89.3026941363

    89.6196513471

    89.7781299525

    89.9762282092

    90.3724247227

    90.6497622821

    91.0063391442

    91.1251980983

    91.3629160063

    91.5213946117

    91.7591125198

    91.9572107765

    92.0364500792

    92.1949286846

    92.3137876387

    92.4326465927

    92.4326465927

    92.6307448494

    92.7892234548

    92.8288431062

    92.8288431062

    92.9873217116

    93.145800317

    93.3042789223

    93.5023771791

    93.6608557845

    93.9381933439

    94.175911252

    94.4136291601

    94.4928684628

    94.6513470681

    94.9286846276

    95.1267828843

    95.2456418384

    100

    * Excludes 'Not Known' cases.

    Hours*

    %

    39%

    57%

    72%

    Sheet1

    Figure 11: Mode of Admission to Operating Hospital Percentages (N=2,664)

    MODE OF ADMISSION

    No2419

    Directly224884

    via First Presenting Hospital or Not Known1757

    Total2664100

    Admission to Orthopaedic Ward

    No32212Figure 12: Admission to Orthopaedic Ward Percentages (N=2,664)

    Not Known141

    Within 4 hours38014

    After 4 hours186070

    Time Interval Not Known883

    Total2664100

    Figure 13: Surgery Performed Percentages (N=2,664)

    SURGERY PERFORMED

    Yes253295

    No923

    Not Known402

    Total2664100

    Surgery the day of, or the day after admissionFigurexx: Time to Surgery Percentages (N=2,532)

    Time to Surgery

    Day of or Day after0

    Later0

    Not Known0

    Total2532

    See additional work file

    Figure 14: Time to and Time of Surgery Percentages (n=2,532)

    Time to and of Surgery

    After 48 Hours69828

    Not Known80.3

    Within 48 Hours and Normal Working Hours176670

    Within 48 Hours but OOH602

    Total2532100

    Figure 15: Reason for 48 Hours+ Surgery Delay (N=698)

    Reason for Delay

    Not Known609

    Other*7411

    Cancelled due to List Over-Run7511

    Awaiting Space on Theatre List8412

    Awaiting Medical Review Investigation or Stabilisation37954

    Awaiting Orthopaedic Diagnosis or Investigation264

    Total698100

    HoursNCum NCum %

    0000.0Figure 16: Cumulative Time to Surgery Percentages (n=2,524)

    1110.0

    2230.1

    3360.2

    44100.4

    53130.5

    64170.7

    79261.0

    87331.3

    910431.7

    1017602.4

    1121813.2

    12271084.3

    13281365.4

    14501867.4

    15642509.9

    166931912.6

    176938815.4

    187246018.2

    1910356322.3

    207263525.2

    218972428.7

    229581932.4

    239891736.3

    247699339.3

    2569106242.1

    2666112844.7

    2767119547.3

    2841123649.0

    2944128050.7

    3033131352.0

    3128134153.1

    3219136053.9

    3315137554.5

    3425140055.5

    3515141556.1

    3624143957.0

    3727146658.1

    3822148859.0

    3929151760.1

    4024154161.1

    4123156462.0

    4234159863.3

    4334163264.7

    4431166365.9

    4545170867.7

    4641174969.3

    4736178570.7

    4841182672.3

    4931185773.6

    5021187874.4

    5119189775.2

    5214191175.7

    5310192176.1

    549193076.5

    558193876.8

    569194777.1

    578195577.5

    589196477.8

    594196878.0

    608197678.3

    617198378.6

    6218200179.3

    6313201479.8

    6418203280.5

    6517204981.2

    6612206181.7

    6721208282.5

    6811209382.9

    6915210883.5

    7012212084.0

    7120214084.8

    7216215685.4

    7312216885.9

    749217786.3

    756218386.5

    7614219787.0

    773220087.2

    787220787.4

    794221187.6

    801221287.6

    817221987.9

    825222488.1

    839223388.5

    846223988.7

    856224588.9

    864224989.1

    875225489.3

    888226289.6

    894226689.8

    905227190.0

    9110228190.4

    927228890.6

    939229791.0

    943230091.1

    956230691.4

    964231091.5

    976231691.8

    985232192.0

    992232392.0

    1004232792.2

    1013233092.3

    1023233392.4

    1030233392.4

    1045233892.6

    1054234292.8

    1061234392.8

    1070234392.8

    1084234793.0

    1094235193.1

    1104235593.3

    1115236093.5

    1124236493.7

    1137237193.9

    1146237794.2

    1156238394.4

    1162238594.5

    1174238994.7

    1187239694.9

    1195240195.1

    1203240495.2

    >1201202524100.0

    PRE-OP ASSESSMENT

    Not Known1546Figure 17: Pre-Operative Medical Assessment Percentages (N=2,664)

    None171965

    Medical Review Following Request34213

    Already Under Care of Geriatrician/Medical Physician472

    Routine by Medical Physician or Specialist Nurse2128

    Routine by Geriatrician1907

    Total2664100

    Figure 17: Pre-Operative Medical Assessment Percentages (N=2,664)

    PRE-OP ASSESSMENT

    Yes1907

    Not Known1546

    No232087

    Total2664100

    TYPE OF ANAESTHESIAFigure 18: Type of Anaesthesia Percentages (n=2,532)

    Not Known743

    Other*602

    SA & Nerve Block35514

    SA Only148359

    GA & SA1084

    GA & Nerve Block1134

    GA Only33913

    Total2532100

    TYPE OF SURGERYFigure 19: Type of Surgery Percentages (n=2,532)

    Other311

    Arthroplasty THR Cemented532

    Arthroplasty THR Uncemented311

    Arthroplasty Hemi Cemented72929

    Arthroplasty Hemi Uncemented44317

    Internal Fixation IM Nail Short29912

    Internal Fixation IM Nail Long2339

    Internal Fixation Screws432

    Internal Fixation DHS67026

    Total2532100

    Figure 20: Type of Surgery Percentages for Undisplaced Intracapsular Fractures (n=297)

    TYPE OF SURGERY FOR UNDISPLACED FRACTURES

    All Other Types103

    Arthroplasty THR Cemented93

    Arthroplasty THR Uncemented83

    Arthroplasty Hemi Cemented11438

    Arthroplasty Hemi Uncemented9131

    Internal Fixatio