Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK.
Department of Trauma and Orthopaedic Surgery, Southmead Hospital, Bristol BS10 5NB, UK.
Age Ageing. 2022 Aug 2;51(8). doi: 10.1093/ageing/afac163.
Trauma in older people leads to substantial morbidity and mortality. The National Hip Fracture Database (NHFD) has driven improved practice with units compared to identify outliers. In 2013, our unit was an outlier for mortality post hip fracture (30-day mortality 12.2% vs. 8.3% nationally). This triggered external review. In 2019 the unit was highlighted as an exemplar in the UK. We describe the process that moved us from outlier to outstanding. After the initial review process, we made changes to our healthcare system, with regular reassessment of progress and care quality. Examples include a dedicated hip fracture unit, strong leadership (Nursing, Orthopaedic, Geriatrician, Anaesthetic), consultant-led in-depth monthly mortality reviews, changes to admission pathways and delirium prevention. Improvements were seen in all aspects of hip fracture care in 2019 compared with 2012. Thirty-day case-mixed adjusted mortality halved (12.2-6.1%), with substantial reductions in reoperations and pressure sores. Length of stay reduced by 5.9 days. In 2019 our unit's performance was significantly above the national average for all six indicators assessed by NHFD: prompt orthogeriatric review (97% vs. 91% national average), prompt surgery (85% vs. 68%); NICE compliant surgery (85% vs. 74%); prompt mobilisation (93% vs. 81%); not delirious postoperatively (77% vs. 69%); return to original residence (78% vs. 71%). The NHFD highlighted our Unit as one of nine (from 175 total) highly performing UK trusts. We summarise our service development and improvement work undertaken to achieve 'outstanding' status, which provides a valuable template to units managing trauma in older people.
老年人创伤会导致大量发病率和死亡率。国家髋关节骨折数据库 (NHFD) 通过与各单位对比，确定异常值，从而推动实践改进。2013 年，我们单位髋部骨折后死亡率异常（30 天死亡率为 12.2%，而全国为 8.3%）。这引发了外部审查。2019 年，该单位在英国成为典范。我们描述了从异常到卓越的过程。在初始审查过程之后，我们对医疗系统进行了更改，定期重新评估进展和护理质量。例如，设立了专门的髋部骨折病房，有强大的护理、骨科、老年医学和麻醉科领导团队，顾问主导深入的每月死亡率审查，改变入院途径和预防谵妄。与 2012 年相比，2019 年髋部骨折护理的各个方面都有所改善。30 天病例混合调整死亡率减半（12.2%-6.1%），再手术和压疮显著减少，住院时间减少了 5.9 天。2019 年，我们单位在 NHFD 评估的所有六个指标中的表现均明显高于全国平均水平：及时进行骨科老年科审查（97%比全国平均水平 91%），及时手术（85%比 68%）；符合 NICE 标准的手术（85%比 74%）；及时活动（93%比 81%）；术后不出现谵妄（77%比 69%）；返回原籍（78%比 71%）。NHFD 强调我们的单位是英国 175 家单位中表现出色的 9 家之一。我们总结了为实现“卓越”地位而进行的服务开发和改进工作，为管理老年人创伤的单位提供了有价值的模板。
