Hip fracture is documented as the most prevalent serious injury in older people. It is both the most common reason for older people to require unplanned anaesthesia and surgery, and the largest cause of mortality following an accident.
The acute hospitals trust in which we work has a clinical pathway for the management of patients presenting with hip fracture, and describes the ‘acute’ phase as lasting up to Day 4 post-operatively.
Clear performance measures exist for the Physiotherapy management of this patient group during the acute phase; as referenced within The National Hip Fracture Database (NHFD):
• ‘Assessed by Physiotherapist on day of, or day after, surgery’ (Assessed by Day 1)
• ‘Mobilised on day of, or day following, surgery’ (Mobilised by Day 1)
Our Acute Orthopaedic Physiotherapy Team is set up with the primary function of managing patients during this acute phase, and has a clear action plan for achievement of the NHFD measures above.
However, due to department staffing shortages, the Rehabilitation Outreach Team (ROT) – which manages patients with hip fracture in their ‘sub-acute’ phase of post-operative rehabilitation – was required to temporarily discontinue. This consequently required our Acute Orthopaedic Physiotherapy Team to be responsible for managing patients over a much greater scope of the post-operative pathway.
The ROT has now been re-established, and so this project sought to assess the impact of the presence of a ROT upon Acute Orthopaedic Physiotherapy Team performance in relation to the above NHFD measures.
Data regarding performance for these NHFD measures was retrospectively collected for two patient sample groups:
• 150 consecutive patient admissions for surgical management of a hip fracture during the phase when there was no ROT
• 150 consecutive patient admissions for surgical management of a hip fracture from the date that the ROT was re-established
Results: With reference to the NHFD measures above:
• Assessed by Day 1 increased from 96% to 99.3% with the re-introduction of the ROT
• Mobilised by Day 1 increased from 74.7% to 82.7% with the re-introduction of the ROT
Conclusion(s): The project results clearly reinforce the positive impact that the presence of a ROT has upon our Acute Orthopaedic Physiotherapy Team performance for the management of patients presenting with hip fracture.
Cost and savings
No project cost implications. Potential savings were not evaluated as part of this project.
The ROT is now firmly re-established; and this project highlights some of the great value and impact of its support to our service.
All information above has been shared with relevant stakeholders for reference.
Top three learning points
- Partnership working between Acute and Rehabilitation Physiotherapy teams can have a wholly positive affect upon outcomes for patients admitted to hospital with a fractured hip.
- Rehabilitation remains an essential component of recovery for patients undergoing surgical fixation of a fractured hip, even in an acute hospital setting
- Use of data contained within the National Hip Fracture Database can provide a useful trigger for service improvement project work
There were no funding implications to this project.
1) Royal College of Physicians. National Hip Fracture Database annual report 2018. London: RCP, 2018
2) The National Hip Fracture Database – www.nhfd.co.uk
3) National Institute for Clinical Excellence. Hip Fracture: Management – Clinical Guideline 124 (2017)