Using CSP Hip Fracture standards to review quality of hip fracture rehabilitation in a central London hospital Trust.

Purpose

Hip fracture surgery is more successful now so that many people are living longer after hip fracture, however the quality of hip fracture rehabilitation is variable (HipSprint 2018).

The CSP published Hip Fracture rehabilitation Standards in 2018. These draw together relevant national clinical standards that relate to hip fracture and place a physiotherapy perspective at the centre of optimal rehabilitation provision.


This local audit was undertaken to measure local practice against these standards. To measure current practice provided in the acute, first seven days of hip fracture rehabilitation within a local DGH, to support improved quality of care within the early part of the hip fracture rehab pathway, to provide evidence to support future quality improvement initiatives.

82.6%
of patients were mobilised on the day of or the following day post hip fracture surgery (2018 = 69%).
84%
of patients who stayed at least 7 days received physiotherapy of at least two hours in total during the first seven days post-surgery.
19%
of patients d/c before 7 days.
33%
of patients who stayed >14 days received on-going rehabilitation of at least 2 hours per week.

Approach

All patients over 60 years old admitted to PRUH for surgical management of primary fracture neck of femur were included in the audit. Physiotherapy care provided was measured against the CSP Hip Fracture Standards.


Data on Standards 1 and 2 collected via NHFD database and CSP audit tools.

Data on Standards 3, 4 and 7 collected using bespoke CSP audit tools on Excel spreadsheet.

Standard 6 measured against attendance sheet for hip fracture governance meetings.

Standard 5 was excluded as its results were beyond the control of the audit site.

Data collected between January - March 2019 inclusive.

Outcomes

Datasets for 86 patients were included in the audit.

 

  • 100% of patients were assessed by a registered physiotherapist on D0/1 post hip fracture surgery (2018 = 96%)
  • 82.6% of patients were mobilised on the day of or the following day post hip fracture surgery (2018 = 69%).
  • 19% of patients d/c before 7 days.
  • 84% of patients who stayed at least 7 days received physiotherapy of at least two hours in total during the first seven days post-surgery.
  • 33% of patients who stayed >14 days received on-going rehabilitation of at least 2 hours per week.
  • A registered physiotherapist attended 100% of the Hip Fracture Governance meetings.
  • 100% of patients had their assessment findings and rehabilitation plans shared with all relevant rehabilitation providers to enable clear communication with the MDT ( no NHFD data).

 

CSP Hip Fracture standards are having a measurable impact on hip fracture rehabilitation within PRUH.


More patients are seen by a registered physiotherapist and more patients are mobilised out of bed on D0/1 than previously.

Baseline measures on the quantity of rehab provided in the first 7 days, and those continuing rehab within a DGH is now established.

A physiotherapist is a well-established part of Hip Fracture Governance within PRUH. Optimal communication exists within the MDT to promote continuity of hip fracture rehab provision.
This study highlights the need for further discovery around provision of continuous rehab for a proportion of our population group.

Implications

Introduction of national professional standards can positively influence local clinical care delivery.


Audit data provides a robust measure for identifying priorities for future service improvement work.

Clinical reasons for non-compliance with standards need to be captured to further contextualise data and assist targeted service improvement work.

Additional notes

This work was presented at Physiotherapy UK 2019.