The purpose of the audit is to gain a detailed understanding of the physiotherapy management of patients with hip fracture, so that recommendations can be made which will result in improvements. By using a standardised national audit tool, data and information will enable physiotherapists to understand how to improve both the service delivery and the experience of physiotherapy for hip fracture patients. This audit will also demonstrate to external stakeholders the professions readiness to embrace the findings from the audit, in order to make improvements
The standards that inform the audit are primarily derived from NICE CG 124 (Hip Fracture management) and NICE CG 161 (Falls in Older people). The audit will be comprised of clinical observations by physiotherapist and communication with the patient or carer, and will focus on three areas: well-planned rehabilitation, prompt mobilisation and the quality/intensity of rehabilitation. The data will be collected from the same patients over their first 7 days in each of three steps in their pathway: post-operative therapy in the acute ward, initial rehabilitation in any subsequent ward(s), and home based rehabilitation.
To date 149 Acute Trusts and 48 non- acute services have registered an interest in fully engaging with the audit. Local staff in acute units already collect data for the National Hip Fracture Database (NHFD) and will routinely identify all patients aged 60 or older who undergo surgery for a new hip fracture. The audit will follow this same cohort of patients, from the day of operation. Patients will be recruited from May 2nd until the end of June, with 120 day follow-up complete by the end of October.
The results will create strengthened physiotherapy data, linking PHFSA data with NHFD data including
· prompt post-operative mobilisation and any constraints on this;
· physiotherapy assessment performed;
· the nature of physiotherapy provided each day;
· the time and staff involved in providing this;
· length of stay in each stage of the rehabilitation pathway;
· patients' discharge destination;
· recovery of mobility; and
· 120 day follow up of mobility, residential status and quality of life
The audit's purpose is to define the quality and intensity of physiotherapy provided to a key group of patients - patients with hip fracture who, through the NHFD, are already used to define the quality and outcome of the multidisciplinary care offered to frail and older people by the modern NHS.
More robust data will mean that physiotherapists and service commissioners will be able to understand their services more comprehensively and optimise improvement opportunities. The National Hip Fracture Database could include more physiotherapy data on a more permanent basis, enabling sustainability of improvement. This approach to improvement could be applicable to other clinical areas of physiotherapy, and provides the opportunity for the profession to gain real feedback about its impact with frail and older people.
This project is funded by the Chartered Society of Physiotherapy
This work was presented at Physiotherapy UK 2017.