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BMJ. 2007 September 29; 335(7621): 634–635.
PMCID: PMC1995505

UK hip fracture audit is launched to improve care and reduce costs

A new UK-wide audit has been launched to improve the care of patients with hip fracture. The audit aims to help reduce the currently low and variable rates of investigation and treatment of osteoporosis in elderly people who are admitted to hospital with fragility fractures.

The audit system, called the national hip fracture database, will gather data submitted voluntarily by hospitals around the United Kingdom. Its design is based on an audit of myocardial infarction care, the myocardial infarction national audit project (MINAP), which has had a major role in improving the management of heart attack, including reducing the “door to needle time” for use of thrombolytic drugs.

The hip fracture database will audit hospitals against six standards proposed in a guide to best practice, TheBlue Book on the Care of Patients with Fragility Fractures, published last week by the British Orthopaedic Association and the British Geriatrics Society. The standards include admitting all patients with hip fracture to an acute orthopaedic ward within four hours of presentation and performing surgery within 48 hours of admission on all patients who are medically fit.

To prevent hip fractures, one of the audit standards is the assessment of all patients presenting with fragility fracture to determine their need for antiresorptive treatment to prevent future osteoporotic fractures. Another standard recommends that all patients with fragility fractures resulting from a fall should be offered multidisciplinary assessment and intervention to prevent future falls.

The report warns that 75 000 hip fractures occur each year in the UK, costing the NHS about £1.4bn (€2bn; $2.8bn). Given the UK's ageing population, the number of hip fractures is predicted to double by 2050.

Half to two thirds of patients who present with a hip fracture have had a previous fracture, the report notes, which could and should have served as a warning that patients were at risk of further fractures. “Preventive treatment is available but most patients miss out,” it says.

The report and audit have been introduced after a recent UK audit showed that less than 5% of women with a history of fracture underwent a dual energy x ray absorptiometry (DXA) scan for bone density and less than 10% were treated with drugs to reduce the risk of further fractures. Also, care of patients with fracture varied greatly across hospitals.

Colin Currie, a consultant orthogeriatrician in NHS Lothian and senior lecturer in geriatric medicine at the University of Edinburgh, warned: “The current organisation of services for older patients with fractures is poor, with little recognition of osteoporosis as an essentially chronic condition, with flare ups when fractures occur.

“Better co-ordinated services—including early diagnosis and bone protection, optimal fracture care, and secondary prevention—would improve patients' quality of life and reduce the burden of fracture care on the NHS.”

Notes

The Blue Book on the Care of Patients with Fragility Fractures is available at www.boa.ac.uk.


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