SAFE HIP FRACTURES. Dr Karthik Kayan MD FRCP Consultant Physician and Orthogeriatrician Stockport NHS Foundation Trust
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1 SAFE HIP FRACTURES Dr Karthik Kayan MD FRCP Consultant Physician and Orthogeriatrician Stockport NHS Foundation Trust
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3 Why hip fracture? Common in older adult (~84 years) UK current incidence : (Stockport ~375 ) Projected incidence 2015: 460 and 505 in 2020 Hospitalisation Complications Morbidity Length of stay Financial burden Mortality
4 DH Systematic approach to falls and fracture care & prevention: four key objectives Stepwise implementation Hip fracture patients Objective 1: Improve outcomes and improve efficiency of care after hip fractures by following the 6 Blue Book standards Non-hip fragility fracture patients Individuals at high risk of 1 st fragility fracture or other injurious falls Older people Objective 2: Respond to the first fracture, prevent the second through Fracture Liaison Services in acute and primary care Objective 3: Early intervention to restore independence through falls care pathway linking acute and urgent care services to secondary falls prevention Objective 4: Prevent frailty, preserve bone health, reduce accidents through preserving physical activity, healthy lifestyles and reducing environmental hazards DOH 2009
5 NICE guidance Timing of surgery Planning the theatre team Surgical procedures Mobilisation strategies Multidisciplinary management. NICE: CG124, 2011
6 Medical management Anaemia Anticoagulation Volume depletion Electrolyte imbalance Uncontrolled diabetes Uncontrolled heart failure Correctable cardiac arrhythmia or ischaemia Acute chest infections Exacerbation of chronic chest conditions NICE: CG124
7 Multidisciplinary management Acute, orthogeriatric or orthopaedic ward-based Hip Fracture Programme that includes: Orthogeriatrician assessment (pre and post surgery) rapid optimisation of fitness for surgery (medical management) early identification of individual goals for multidisciplinary rehabilitation continued, coordinated, orthogeriatric and multidisciplinary review liaison or integration with related services clinical and service governance responsibility for all stages of the pathway of care. NICE: CG124, 2011
8 Role of Orthogeriatrician Hip fracture programme lead Assessment- pre and post op for hip fractures Support the MDT team Falls risk assessment and management Fracture risk assessment and management (osteoporosis) Early supported discharge
9 National hip fracture databasereports
10 Hip Fracture-Best Practice Tariff Admission under the joint care of a Consultant Geriatrician and a Consultant Orthopaedic Surgeon Admission using an assessment protocol agreed by geriatric medicine, orthopaedic surgery and anaesthesia Surgery in under 36 hours Pre and post op AMTS (From April 2012) Assessed by a Geriatrician within 72 hours of admission Postoperative Geriatrician-directed: Multi-professional rehabilitation team Fracture prevention assessments (falls and bone health) DOH 2010
11 Benefits of BPT Quality of care-compliance with NICE Early surgery Timely management of acute medical problems Orthogeriatrician supported Rehabilitation Prevention of further falls and fracture Financial gain ( 1335/patient above base tariff)~ length of stay reduction cost benefit
12 JOINT CARE HIP FRACTURE UNIT
13 Multidisciplinary team
14 Stockport-30 day hip fracture mortality N= 372, RR 63 ( ) Dr Foster s intelligence
15 30 days hip fracture mortality in England, Wales and N Ireland Dr Foster s intelligence
16 Stockport- Hip Fracture Length of Stay Dr Foster s intelligence
17 Public healthcare outcomes- Future Sustainability of safe hip fracture in line with the Integrated working between primary and secondary care Improve fracture/ falls management for non- hip fractures Health improvement in Older people
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