Aim: To quantify changes in epidemiology, in-patient treatment and outcome of hip fracture patients over seven-year period. This data has provided a baseline of our local changes and provided information for local planning of health care provision for these patients, in terms of improved care pathways, treatment protocols, management with geriatricians, provision for discharge in the future.

Subjects and methodology: Retrospective randomised analysis of in-patient charts of patients with hip fractures admitted to a large 650-bed Acute District General Hospital in 1996 compared with 2003. The following data is gathered: Epidemiological data, baseline test data for anaemia and renal function, time to surgery from admission, post-operative complications, time to discharge from ward and functional outcome. During this time interval we introduced a number of changes to our system of care such as: more junior doctors on the wards, more access to emergency operating time, better post-operative monitoring and care, and a move to a new hospital.

Results: In 1996, the total number of admissions over 6 months was 144 compared to 160 in 2003 for the same time period. The mean age has increased from 83 years compared to 85 years in 2003. Median mental test score declined from 9 in 1996 to 6 in 2003. The mean co-morbidities rose from 1.7 in 1996 to 2.8 in 2003. 11% of patients were medically unfit for surgery in 1996 compared to 30% in 2003 resulting in delay in time to theatre. 33% of patients were admitted from nursing homes in 2003 compared to 22% in 1996. The mortality rate was 12% in 1996 compared to 18% in 2003.

Conclusion: This study demonstrates that deteriorating pre-operative status in terms of age, ASA, mental test score and co-morbidities seems to have negated any of the system changes we introduced to improve our service. Some of our results are at variance with some national trends, highlighting the importance of undertaking this type of study locally. In our situation this was all the more surprising, given that demographically we have a relatively young population in Swindon compared to the national statistics. Performance and National League table results must take into account these demographic variances.