All 174 trauma units in England, Wales and Northern Ireland regularly uploaded data describing the process, quality and outcome of the care they provided to the 67,302 people who presented with hip fracture in 2019. This report uses six NHFD key performance indicators (KPIs) to describe how the quality of care varies between hospitals and changes over time. The impact of COVID-19 on patient care and the organisation of trauma services will be examined in detail in next year’s NHFD report, but this year’s report helps units measure their readiness and prepare for the challenging time that we continue to face.
Hip fracture is a serious and costly injury affecting mainly older people, and is more common in women. It usually results from the combination of weak bone structure (osteoporosis) and a fall. Around 76,000 hip fractures occur each year in the UK as a whole. Although there is good evidence on best practice in surgical, medical and rehabilitation care following hip fracture, such care and its outcomes – in terms of return home and also of mortality – continues to vary.
The National Hip Fracture Database (NHFD), which was launched in 2007, aims to deliver improvements in the care of hip fracture patients. It documents case-mix, care and outcomes of hip fracture patients in England, Wales and Northern Ireland and is now, with more than 500,000 cases on record – by far the largest hip fracture audit in the world.
It has demonstrated broad improvements at local and national level in patient care, and in England has supported the Department of Health’s highly successful Best Practice Tariff for hip fracture care. The work of the NHFD is now being replicated in Ireland, with the recent launch of Irish Hip Fracture Database, and similar developments are in hand in Australia and New Zealand, Canada and Hong Kong.
The National Hip Fracture Database was founded as a collaboration between the British Orthopaedic Association and the British Geriatrics Society. It was developed between 2004 and 2007, and since 2009 it has received central funding as a national clinical audit via the Healthcare Quality Improvement Partnership (HQIP). Since April 2012 the NHFD has continued as part of the Falls and Fragility Fracture Audit Programme, managed on behalf of HQIP by the Royal College of Physicians (London).
The audit covers England, Wales, Northern Ireland and the Isle of Man, however data files only refer to data for England and Wales.