Collection of new data for the Scottish hip fracture audit stopped in December 2008. The proposed standard of operating on 98% of all hip fractures within 24 hours of admission, subject to medical fitness and during safe operating hours should now be maintained. Methods. We prospectively collected data from 102 consecutive hip fracture patients documenting the patient's journey from admission to discharge from the orthopaedic ward to look at whether the standard had been maintained. Results. 50% of patients get to theatre 24hrs or earlier with 60% catheterised perioperatively.50% of patients were moved from the acute orthopaedic facility at a week with less than 20% of these getting back to their usual place of residence. 25% were still on the acute ward at two weeks and 3% died in the immediate post operative period. However, the number of co-morbidities did not seem to correlate with time to discharge. The majority of patients transferred to onward care moved to the geriatric rehabilitation ward within the hospital. Prioritisation of hip fracture patients on the trauma list needs to be continued along with improvements in the availability of rehabilitation beds. Pre-operative medical work up for patients with reversible illness and post-operative geriatric care will improve the outcomes for these frail patients

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 1. st. April to 31. st. 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 stay. 2–4. , 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 admission. 6. . 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

Hip fracture is a common and serious injury affecting the elderly. Many patients have co-morbidities which may need to be investigated and treated before surgery but, conversely, delay in surgical management of these patients leads to increased morbidity and mortality. The Scottish Hip Fracture Audit (SHFA). 1. conducted in 2007 showed variations between hospitals in postponement rates for medical reasons. The report referred to 11 major clinical abnormalities described by McLaughlin. 2. that were associated with poor postoperative outcomes and should be corrected before surgery. This prospective audit took place in Monklands hospital for a duration of 6 weeks. All patients admitted to the orthopaedic firm from 14. th. Oct 2012 to 26. th. November 2012 with confirmed fracture neck of femur were prospectively included in the audit. A detailed review of the notes took place to identify whether delays were appropriate according to McLaughlin. There were a total of 23 patients admitted during the audit period of which 21 were operated on and 2 patients treated conservatively. The mean age of this cohort was 82.8 (range 55–91) with a male to female ratio of 1:1.3. Sixteen cases (76%) were operated on within 48 hours of admission (11 cases – 52% within 24 hours). Five cases (24%) were delayed by more than 48 hours. Three cases (14%) were delayed due to lack of theatre time. Two patients (9.5%) were delayed due to request of ECHO for ?new murmur. Our practice of managing hip fracture patients is similar to other units in Scotland with a deferral rate of approximately 25%. The patients who have a major clinical abnormality were appropriately investigated and treated before the surgery. Further improvement in management of the theatre time is needed as surgery is delayed for >24 hours in approximately 15% of medically fit hip fracture patients

Troponin I is a widespread used blood test to confirm myocardial damage, usually attributable to myocardial infarction. Troponin tests require to be taken 12 hours after the initial event, and thus may be a potential cause for delay. SIGN and Hip Fracture Audit guidelines recommend 98% of patients obtaining surgery within 24hrs of admission. A population of 347 neck of femur patients presenting to Glasgow Royal Infirmary were assessed over a one year period. 44 (13%) Patients were identified as having a pre-operative Troponin I test. Retrospective case note review of this patient cohort who had pre operative troponin testing was undertaken to identify timing of TnI testing, admission, surgery and medical comorbidies. Time to theatre was compared with the 24hr guideline. From the cohort, 32 Patients had case notes which were located, of which 4 had no filed notes from the admission giving a 28 patient sample population. 18 (64%) had a Troponin of ‘negative’ value (<0.04 μg/l) of which the mean delay to theatre from admission was 46.4 hrs (median 44.5hrs). All 18 breached the 24hr target, 5 were delayed >48hrs. Of the 10 ‘postive’ patients, mean TnI was 0.4 and time to theatre was 85hrs (median 69hrs) with one excluded as treated conservatively. Only one patient was treated within the 24hr target (3.7% of sample group treated operatively) p=<0.001. Scottish Hip Fracture Audit shows GRI to have an overall 98.6% compliance with the 24hr target. The data presented shows significant (near complete) failure to meet the 24hr target in patients tested preoperatively for Troponin I. Almost three-quarters of these patients have normal TnI, but delay may be attributable to additional comorbidities