Wimalasena Bodhi, Harris Roger
Older People's Health, Auckland City Hospital, Private Bag 92024, Auckland Mail Centre, Auckland 1142.
N Z Med J. 2016 Jul 1;129(1437):15-26.
The aims of this audit were to collect the Minimum Data Set outlined by the Australia New Zealand Hip Fracture Registry (ANZHFR), assess patient characteristics, analyse process of care, and evaluate how this compares to NICE guidelines for hip fracture care, as well as to Auckland Hospital data from 2007.
Retrospective case record audit of patients with fractured neck of femur aged 65 years and over admitted under Orthopaedics over a 4-month period in 2013.
Ninety-one patients were audited; mean age was 83 years, 68% were female. Both inpatient and 30-day mortality was 5%. 120-day mortality was 15%. Seventy-six percent of patients were admitted from ED within the national health target prescribed period of 6 hours. Only one patient was treated non-surgically. Eighty-six percent had surgery within 48 hours of admission. Eighty-two percent of patients had rehabilitation and treatment by Older People's Health. Of those living at home pre-fracture, 76% returned home on discharge. Thirty-seven percent of patients were able to walk unaided prior to hip fracture, but only 1% on discharge. Average overall length of stay was 22 days. Bisphosphonates were prescribed for 56% of patients.
Compared to 2007, Auckland City Hospital has demonstrated a significant improvement in the rate of provision of timely surgery for hip fracture patients. Most patients are receiving the guideline recommended fracture-specific surgical interventions. The assessment and treatment of osteoporosis needs further attention.
本次审核旨在收集澳大利亚新西兰髋部骨折注册中心（ANZHFR）概述的最小数据集，评估患者特征，分析护理过程，并评估其与髋部骨折护理的英国国家卫生与临床优化研究所（NICE）指南以及奥克兰医院2007年数据的对比情况。
对2013年4个月期间骨科收治的65岁及以上股骨颈骨折患者进行回顾性病例记录审核。
共审核了91例患者；平均年龄为83岁，68%为女性。住院死亡率和30天死亡率均为5%。120天死亡率为15%。76%的患者在国家卫生目标规定的6小时内从急诊科入院。仅1例患者接受非手术治疗。86%的患者在入院后48小时内接受手术。82%的患者接受了老年人健康服务的康复和治疗。骨折前在家居住的患者中，76%出院时回家。37%的患者在髋部骨折前能够独立行走，但出院时只有1%能够独立行走。平均总住院时间为22天。56%的患者开具了双膦酸盐类药物。
与2007年相比，奥克兰市医院在为髋部骨折患者及时提供手术的比例方面有显著改善。大多数患者正在接受指南推荐的针对骨折的手术干预。骨质疏松症的评估和治疗需要进一步关注。
