Patel Nirav K, Sarraf Khaled M, Joseph Sarah, Lee Chooi, Middleton Fiona R
Department of Trauma and Orthopaedic Surgery, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames KT2 7QB, UK.
Injury. 2013 Dec;44(12):1934-9. doi: 10.1016/j.injury.2013.04.012. Epub 2013 May 13.
Hip fractures are common injuries in the elderly, with significant associated morbidity and mortality rates. The National Hip Fracture Database (NHFD) was implemented to audit care according to national standards thus improving its clinical and cost-effectiveness.
We retrospectively examined the care pathway for all hip fractures after its introduction at our centre over 1 year, with an audit of care according to the BOA-BGS 'Blue Book' guidelines. Data between the first (period 1: initial audit) and second (period 2: re-audit) six months of the study period were compared.
There were 372 patients (28% male, 72% female) in total with 190 in period 1 and 182 in period 2. For all patients, the median age was 85 years (range 33-101) and the median time to surgery was 24.5h (1-519.3), with 251 (67.5%) within 36h. Surgical delay was mainly due to lack of theatre space (37.6%) and medical reasons (54.7%). The median length of stay was 11 days (2-92) and the inpatient mortality rate was 6.2% (23). When comparing the two study periods, there were significantly more patients undergoing falls (p<0.01) and bone protection (p<0.01) assessments in period 2. Lack of theatre space was a significantly less common (p<0.01), with a significantly shorter median time to surgery (p=0.01) and length of stay (p<0.01) in period 2. More patients were discharged to rehabilitation units and the mortality rate was non-significantly lower in period 2 (7.4% vs. 5%). The best practice tariff was met in 45.3% and 70.3% (p<0.001) of patients in periods 1 and 2 respectively providing a total income of £95230.00 (GBP).
Implementing the NHFD has led to an improvement the quality of hip fracture care according to national guidelines. More patients were assessed by an orthogeriatrician, with a shorter time to surgery and length of stay following re-audit. There is potential for an improvement in mortality rates as well as significant financial income for hospitals.
髋部骨折是老年人常见的损伤，伴有显著的相关发病率和死亡率。国家髋部骨折数据库（NHFD）的建立是为了根据国家标准审核护理情况，从而提高其临床效果和成本效益。
我们回顾性研究了我院引入髋部骨折护理路径1年多来所有髋部骨折患者的护理过程，并根据英国骨科协会-英国老年医学会（BOA-BGS）的“蓝皮书”指南进行护理审核。比较了研究期前六个月（第1阶段：初次审核）和后六个月（第2阶段：再次审核）的数据。
共有372例患者（男性28%，女性72%），第1阶段190例，第2阶段182例。所有患者的中位年龄为85岁（范围33 - 101岁），手术中位时间为24.5小时（1 - 519.3小时），其中251例（67.5%）在36小时内接受手术。手术延迟主要是由于手术室空间不足（37.6%）和医疗原因（54.7%）。中位住院时间为11天（2 - 92天），住院死亡率为6.2%（23例）。比较两个研究阶段，第2阶段接受跌倒评估（p<0.01）和骨保护评估（p<0.01）的患者显著增多。手术室空间不足的情况显著减少（p<0.01），第2阶段的手术中位时间显著缩短（p = 0.01），住院时间显著缩短（p<0.01）。更多患者出院后进入康复单位，第2阶段的死亡率略低（7.4%对5%），无显著差异。第1阶段和第2阶段分别有45.3%和70.3%的患者达到最佳实践收费标准，总收入为95230.00英镑（英镑）。
实施NHFD已使髋部骨折护理质量根据国家指南得到改善。更多患者由老年骨科医生进行评估，再次审核后手术时间和住院时间缩短。死亡率有改善的潜力，同时医院有显著的经济收入。
