National Waiting Times Unit - Hip Fracture Delivery Team 

2008 NWTU Time to Theatre Compliance

In 2005, members of the SHFA Steering Group were invited to join a Scottish Executive National Waiting Times Unit (NWTU now Health Delivery, Access Support Division) Hip Fracture Delivery Team to bring together the work of the SHFA with the local delivery plans submitted to the Scottish Executive by each NHS Board as they relate to delivery of the Hip Fracture Target announced in Fair to All, Personal to Each, 2004:

Fair to All, Personal to Each, 2004: By December 2007, patients will be operated on within 24 hours from admission to a specialist unit for hip surgery following fracture.

This work culminated in the NWTU's proposed operational standard:

The Operational Standard: By December 2007, 98% of all hip fracture patients are to be operated on within 24 hours of  admission to an orthopaedic unit, subject to medical fitness and during safe operating hours (8 am – 8 pm, 7 days a week).

See Decision Tree showing how compliance with the target was calculated for the 2005 national data set.  

This target was intended to improve the quality of care for this frail elderly population. Whilst it is unlikely to have a direct impact on patient mortality, it may well reduce morbidity, although this is difficult to measure.  

Three years of NWTU funding to March 2009 were secured, facilitating 100% coverage of local SHFA data collection across all units on the Scottish mainland. SHFA circulated monthly Realtime Reports to all units, informing them of their latest month’s target compliance and listing patients who were medically unfit for theatre or who missed the target. See 2008 NWTU Time to Theatre Compliance for each hospital’s Time to Theatre performance in 2008.  

If local clinicians or management teams thought it would be helpful, the Hip Fracture Delivery Team were happy to make site visits offering support and advice in achieving the target. Similarly, if a hospital reviewed a patient’s management and considered that the delay was for justifiable medical reasons (not system or process delays), SHFA initiated a review process.  

The data also fed into the HEAT indicators (Health Improvement, Efficiency, Access and Treatment) produced by the Scottish Government to assist the Boards in monitoring performance.