121DELIVERING “BEST PRACTICE” FOR PATIENTS WITH HIP FRACTURE - DOES ORTHOGERIATRICIAN ENGAGEMENT WITH NATIONAL CLINICAL AUDIT DATA IMPROVE PERFORMANCE?

Abstract

Introduction: Since 2007 the National Hip Fracture Database (NHFD) has operationalised standards set by the British Orthopaedic Association (BOA), British Geriatrics Society (BGS) and National Institute for Health and Care Excellence (NICE). The NHFD measures performance and outcome against these standards, and uses this data to support the administration of the 'payment by results' programme with which NHS England has promoted investment in orthogeriatric services. We set out to examine orthogeriatricians' engagement with the NHFD as a tool for clinical governance. Method: We identified compliance with 'best practice' criteria based on the 'Blue Book' (BOA-BGS 2007) for all 161 hospitals in England which provide hip fracture care. We set units' performance against the engagement of their lead clinician with the web-based clinical governance data provided at www.nhfd.co.uk up to 1st August 2015. Results: Mean best practice tariff (BPT) attainment increased from 38% to 63% over the three years 2012-14. By 2014 units where the lead clinician was accessing NHFD data on a monthly basis were averaging 68% of BPT - significantly higher than the 57% attained in units where the lead had not accessed data for over 6 months. Consultant orthogeriatricians were NHFD lead clinician in 50 units (31%) and in 15 other units (9%) they shared this role. Such units had significantly higher BPT attainment (64% and 68% respectively) than the 54% seen in 96 units (60%) with a consultant orthopaedic surgeon as sole NHFD clinical lead (p < 0.001). Discussion: BPT attainment was > 10% higher in units where NHFD data is regularly accessed. For an average hospital admitting 350 cases per year this would amount to an additional income of over 45,000. Many units should look to this figure to support further investment in orthogeriatrics to improve clinical governance and patient care.