Scottish Hip Fracture Audit
The patient journey post hip fracture: What constitutes rehabilitation?


Hip fracture is a common serious injury, which occurs predominately in the elderly. The care of hip fracture is multidisciplinary and resources vary across the country. The Scottish Hip Fracture Audit (SHFA) (see contacts for current Steering Group and subgroups) aims to improve hip fracture care by providing robust nationally comparable data on the care of hip fracture patients (see Objectives).

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The audit started in 1993 in four hospitals, funded by the Clinical Resource Audit Group (CRAG). Since March 1999, the Information Services Division (ISD) of NHS National Services Scotland have met central co-ordinating costs. Whilst data collection has historically been funded locally, temporary Scottish Government funding allowed full coverage of mainland hip-fracture operating hospitals in 2007 and 2008. New data collection stopped in December 2008 when the resource was transferred to an audit of Musculoskeletal Access (MSK).

In 2004, following a comprehensive standardisation and validation of local hospital databases, SHFA developed a single national database of audited hip fractures, ultimately incorporating data from all mainland Scotland hip fracture operating hospitals. We also re-launched data collection proformas and instructions, standardised across the country, and provided non-participating hospitals with temporary audit staffing to achieve full national coverage for the first time. This national database, now updated to 2008, provides a valuable tool for audit, management and research of this frail and vulnerable group of patients.

Key Priorities
  • SHFA core data has provided hospitals with a succinct and clear overall description of the complex process of hip fracture care in their orthopaedic departments (see Annual Reports for more detail), and a means of comparison of the varying multidisciplinary care at different centres.

    In addition to core data collection, SHFA has also carried out a series of time-limited audits that allow various areas of hip fracture care to be investigated in more detail. These have included:

        Hip fracture rehabilitation (see SHFA Rehabilitation Report 2009)

        Postponement of surgery for medical reasons (see SHFA Clinical Decision Making: Is the Patient Fit for Theatre?)

    Another major area of interest has involved working with the Scottish Government's Access Support Division (formerly known as National Waiting Times Unit (NWTU)) to reduce unnecessary waiting times to surgery following hip fracture. Monthly “real-time” reports were sent to each hospital, allowing them to monitor their performance against agreed local delivery plan targets, and to identify and review patients that miss these targets. See NWTU Time to Theatre Targets for more detail.
Data Collection

SHFA included all patients aged 50 or over who sustained a hip fracture, regardless of pathology or mechanism of injury. A standard core dataset was collected during the patient's acute stay, and at four months post-acute admission. The four-month review data was predominately collected by telephone to patients or their carers, although standardised postal questionnaires were used when necessary.

Data was collected on-site by dedicated Local Audit Co-ordinators, who submitted each hospital’s data to a central ISD team comprising a Clinical Co-ordinator, a Statistician and a Data Co-ordinator (see Contacts for more details). The SHFA collected complete and accurate data, using standardised data collection proformas and procedures (see proformas), sub-contracted dual data entry and thorough electronic validation processes.