The Scottish Hip Fracture Audit

Hip Fracture Standards – Quality Improvement

The Scottish Hip Fracture steering group aims for delivery of the highest quality of care to maximise the potential of a positive outcome for hip fracture patients.

Scottish Standards of Care for Hip Fracture Patients

Scottish Hip Fracture Standard 7 Cemented Hemiarthroplasty as Standard - Evidence List download pdf[161 Kb]

Scottish Standards of Care for Hip Fracture Patients - Summary - January 2023 download pdf[89 Kb]

Monthly Reports

These reports provide information on the proportion of patients who have and have not achieved the standards of care at individual hospital level. Please visit our Reports page for more details.

Exception Reports

In order to facilitate the monthly review of progress in achieving the national standards of care, hospitals are supplied with an ‘exceptions list’ containing details of all patients who did not achieve a particular standard. Where a small number of cases have not achieved a standard this may require individual case review, however where multiple patients have not achieved a standard this usually indicates an issue with a process.

Download Example of an Exception Report download example of an exception report pdf [212KB]

Annual Reports

Visit our Reports page for further information.

Scottish National Audits Programme Governance Process

The Scottish National Audit Programme (SNAP) governance process provides a framework for identifying where patient outcomes may be significantly different in individual hospitals and mandates investigation to better understand why this may be the case. This is an annual process and is further explained in the diagram below;

Diagram showing the steps for further investigation why patient outcomes may be significantly different in individual hospitals and the actions needed to investigate and resolve the reasons behind this. The Outliers where patient outcomes do not meet the standards are identified in annual KPIs through informal communication with audit leads.  Following this, the NHS Health Board Medical Director is informed of the situation and support and advice is offered from the relevant teams.  The Clinical team perform investigations and develop an action plan. The SHFA Steering group may request further details and ensure timelines agreed. At this point, ongoing support and review of progress and improvement is ensured before implementation of an action plan. If no resolution of the problems identified are made then these are escalated to ensure that the issues can be raised with Boards once again.

The Scottish Hip Fracture Audit (SHFA) currently use the following 6 key performance indicators (KPIs):

    • Hip fracture not repaired within the 36-hour standard patients.
    • Cemented hemiarthroplasty not used to repair the fracture.
    • No comprehensive geriatric assessment (CGA) within the three-day standard.
    • Did not return to their original place of residence within 30 days of admission.
    • Readmission after 14 days.
    • Numbers of patients who died within 30 days of admission.