Transcript RCP bone health and NHFD database

RCP bone health and NHFD
database
Neil Pendleton
Senior lecturer Geriatric Medicine
University of Manchester and Salford
Royal NHS Foundation Trust
RCP bone health and NHFD
database
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Two independent projects
(communication exists)
RCP falls and bone health audit October
2006
National Hip Fracture Database (NHFD)
commenced October 2007
RCP falls and bone health
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Salford collaborative approach led Dr Pyburn,
included orthopaedic, orthogeriatric,
community falls and osteoporosis services
Collection data on date via A+E registration
data of 20 hip and 40 other (upper limb)
fragility fracture patients
Large data collection audit tool based on: NSF
chapter 6 ‘falls’; BOA blue book v1; SIGN
number 56 hip fracture management 2002;
NICE CG21 (falls) 2004; Nice HTA 87
(secondary prevention osteoporosis) 2005
RCP falls and bone health
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172 0f 172 of acute care trusts agreed
to participate with 157 supplying data
(91%)
174 PCT’s were identified as eligible and
146 assisted with data collection for the
audit.
Report comprehensive and site specific
and data summarized in domain scores
RCP falls and bone health
RCP falls and bone health
RCP falls and bone health
RCP falls and bone health
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Recommendations
PCT to commission care pathways falls and osteoporosis for
patients with first fragility fracture
Acute trust review services for NOF patients
PCT to commission clinics to offer falls and osteoporosis
assessment indicated in first point
PCT to review exercise options locally
DOH to consider osteoporosis treatment in QOF
Primary and secondary care to share documents/data on
fragility fracture patients
Primary and secondary care to review information sharing and
governance/audit agreements relevant to above
National Hip Fracture
Database
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A joint initiative between the British Orthopaedic
Association and British Geriatrics Society
Aims: to focus attention on hip fracture both locally
and nationally; benchmark its care across the
country; use continuous comparative data to create a
drive for sustained improvements in clinical standards
and cost effectiveness
Voluntary participation, SRFT taken part since
October 2007
Sections publishing best practice, BOA/BGS Blue
Book Version 2 and literature database for neck of
femur fracture
National Hip Fracture
Database
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Demographics from first year data
Approximately third are 75-84 years and third 84-95
years, with 75% female
Discharge (including death), 73% less than 20 days
and 88% less than 30 days (c.f. national 74% and
87.5% respectively)
Facilities audit shows we have 50% national figure
for medical and specialist nurse provision for hip
fracture patient care.
Mortality 30 days 7.8% versus national 8.4% (ONS)
National Hip Fracture
Database
30/12/2008
B2B indicator
Year 2007 (%)
Year 2008 (%)
NHFD total
(%)
Time to ward
=<4hours
>4hours
48(83)
10(17)
151(83)
32(17)
16958(78)
4686(22)
Time to surgery
=<24hours
=<48hours
19(32)
44(74.6)
78(44)
124(69.3)
667(31)
13846(63.8)
No. of Patients
with pressure
ulcers
Develop ulcers
9(14.8)
36(18.4)
829(3.7)
Routine assess.
Assessed
4(6.7)
56(30.4)
5108(23.4)
Antiresorptive
therapy
On therapy
33(54.1)
112(57.1)
9198(40.9)
Falls assessment
Assessed
32(53.3)
98(53.3)
7184(32.9)
RCP and NHFD programmes
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Participation in both projects valuable: change has
resulted
Measure the patient demographics, service provision
in existence and relate this to that which should be
provided
Both projects continue, with a further audit by RCP
this year and continuous participation in NHFD
Demonstrates Salford committed to working
collaboratively to measure and improve performance
in management of adults with fracture