33BEST PRACTICE TARIFF FOR FRAGILITY HIP FRACTURES - A COMPLETED AUDIT CYCLE IN A DISTRICT GENERAL HOSPITAL

Abstract

Introduction: Fragility hip fractures are the most common serious injury in older people, costing the NHS and social care around £1 billion per year. Aim: We conducted a two-cycle audit assessing our compliance with the Best Practice Tariff, and exploring the cases that failed to comply. Method: Two audit cycles were completed. The first cycle included patients from May 2016-May 2017, and case notes and electronic records were retrospectively analysed. Changes to practice were implemented after the first cycle, including a dedicated Saturday Orthopaedic Trauma operating list (previously Saturday operating was on a shared CEPOD list), improvement work to the Neck of Femur Fracture clerking proforma, and educational work. Additionally, a new orthogeriatic lead consultant started during this period (TK). A re-audit was performed from August - December 2017. Database data was analysed and cross-referenced with written and electronic records. Results: The first cycle included 58 cases, and the second cycle included 53 cases. The new orthogeriatric lead consultant led to improved contemporaneous records. In the first cycle, 71% (41/58) of cases fully complied with BPT, which remained similar at 70% (37/53) compliance for the second cycle. The majority of cases failing to comply with BPT were as a result of delay to surgery (>36 hours). This was the case for 26% (15/58) of patients in the first cycle, which reduced slightly to 24.5% (13/53) for the second cycle. The circumstances of the failing cases were analysed. In the first cycle, 16% (9/58) had surgery delayed due to lack of theatre capacity, compared with 13.2% (7/53) for the second cycle. In both cycles, a few patients failed to comply for other reasons, usually as a result of medical optimisation for theatre or a missing component of the multi-disciplinary assessment. Conclusions: Our overall BPT compliance rate of 70% is largely unchanged and remains considerably higher than the currently reported national average of 62.1% (November 2017). The proportion failing due to delayed surgery shows improvement (24.5% from 26%). Furthermore, there are reduced delays as a result of limited theatre capacity (13.2% from 16%), which may be partly related to the implementation of a dedicated Saturday Orthopaedic Trauma list. Further work is needed in the future to evaluate the ongoing impact of these interventions and make further improvements.