THE FRACTURE NECK OF FEMUR PROJECT

Abstract

Background: A good hospital guide published in 2006 identified high in-hospital mortality rates in fracture neck of femur patients at the University Hospitals of Leicester NHS trust. The trust was identified as the worst in the country in terms of the percentage of patients having surgery within the recommended 48 hours from admission. The problem had already been identified and a ‘Fracture Neck of femur project’ was launched in January 2006 to improve outcomes in these patients. This included the introduction of trauma coordinators and clinical aides who prepared patients for surgery, a separate fracture neck of femur ward, a discharge nurse, dedicated hip fracture lists and pre and post operative orthogeriatric input.

Aim: The aim of this study was to assess the impact of the fracture neck of femur project.

Methods: Data on admissions, time to theatre, length of stay and mortality was collected for 3400 patients admitted with fracture neck of femur between January 2003 and September 2007. Mortality rates, length of stay and time to theatre were compared before and after the introduction of the fracture neck of femur project.

Results: The length of stay reduced from 32 days to 18 days in 2007 (p< 0.01). The in-hospital mortality reduced from 16.6 % in 2003 to 10.7% in 2007 (p< 0.01). 30 day mortality showed a minor reduction from 12.4% in 2003 to 11.4% in 2007 (p=0.6). 95% of patients had surgery within 48 hours as compared to 47% in 2005–06 and 85% in 2006–07.

Conclusions: The high in-hospital mortality rates were reduced. The length of stay was also reduced by effective discharge planning. Measures to reduce time to theatre were highly successful. However, the 30 day mortality did not show a significant reduction. We conclude that in hospital mortality is not a good comparator of hospital performance. 30 day mortality would be more accurate.