Abstract
BACKGROUND
Since 1996, the Scottish Hip Fracture Audit (SHFA) group have published reports on the outcomes of patients with hip fractures. In the 2008 report, the group outlined the target standard that “98% of medically fit patients who have sustained a hip fracture should be operated on within 24 hours of ‘safe operating time’ (i.e. between 8 am and 8pm, seven days a week).”1.
AIM
We aim to investigate the compliance of our unit to the SHFA target standard.
METHODS
We prospectively examined patients who were admitted with hip fractures between 1st April to 31st July 2011. These included admissions from A&E and inpatients. Patients who did not receive surgical treatment were excluded. Information was collected using the same pro forma as the SHFA group.
RESULTS
There were 72 patients with hip fractures in that period. One patient (1.4%) was considered unfit for surgery and therefore excluded. Sixty-five patients were considered fit for surgery on first assessment and 61 (93.8%) had surgery within the target time. There were three patients (4.6%) whose diagnosis was delayed waiting for MRI. The waiting period included a weekend in two patients, when there were no MRI facilities. Only one patient (1.5%) had surgery delayed due to lack of theatre availability.
DISCUSSION
Having surgery performed as early as possible is associated with a beneficial impact on morbidity, complications and length of hospital stay2–4, reflected with SIGN guidelines stating “surgery should be performed as soon as the medical condition allows”5 and NICE recommending surgery within 48 hours of admission6.
CONCLUSION
Although our rate of 93.8% does not meet the target standard, it represents an improvement from the published rate (91.2%) in 2008. It also highlights the areas for improvement in patient care, particularly in getting MRIs swiftly to avoid delays.
