Abstract
The Scottish Hip Fracture Audit started in four hospitals in 1993. To date, all except two, hospitals doing hip fractures have been involved in the audit. Participation has been intermittent due to a lack of funds to pay for the audit staff.
Nonetheless there are now 19,000 patients recorded on the database. This allows individual hospitals to compare their workload over time and to compare local data with national comparators.
Unfortunately many of the outcome parameters involve soft end points such as the delay in operation or the proportion of patients who are sent for formal rehabilitation.
Much of the data has simply confirmed what surgeons have always suspected. The injury is becoming more common, the patients are getting older and the patients are becoming less fit.
Co-morbidities are frequent and the strongest predictor of mortality is the age of the patient at presentation.
What the audit has done from a surgeon’s viewpoint is to define the general lack of resources devoted to this injury and to provide evidence which has been used in many hospitals particularly to increase the availability of operating time. Equally as no surprise comes the realisation that surgery is often the least part of the care of these patients. Evidence from the audit has allowed many hospitals to encourage greater participation by geriatricians in the overall care of these patients. The use of the specialist nurse in hip fractures who has responsibility for all aspects of care including follow up has been particularly useful and is recommended in all units. There are however, two huge problems arising from this data. The first, is that the existence of the data means there is something which can be measured and in consequence this has been used as a management tool to measure performance yet where hospitals have been found lacking, resources have not always been made available to improve performance. The second and newer problem relates to the existing anonymity of data. At present the system is very much like critical incident reporting in the airline industry and no surgeon, anaesthetist or hospital is individually identified in any of the published data. The Freedom of Information Act, which has recently come into force in the UK, may now make is possible for anyone to obtain individual named data on both doctors and hospitals. While threatening, this development now seems inevitable but may discourage full participation in future audit.
In spite of these concerns individual clinicians remain enthusiastic about the audit and England, Wales and Northern Ireland have shown considerable interest in developing the audit into a UK wide system.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
