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 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 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 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

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 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 Demographics from first year data Approximately third are years and third 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 B2B indicatorYear 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 ulcers9(14.8)36(18.4)829(3.7) Routine assess. Assessed4(6.7)56(30.4)5108(23.4) Antiresorptive therapy On therapy33(54.1)112(57.1)9198(40.9) Falls assessment Assessed32(53.3)98(53.3)7184(32.9) 30/12/2008

RCP and NHFD programmes 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