Using a national clinical standard for hip fractures reduces the risk of death and significantly improves patient outcomes, a study has found.
A report from Neuroscience Research Australia (NeuRA), published in the Medical Journal of Australia, showed than when patients received high-quality care in line with the Hip Fracture Clinical Care Standard there was a significant decrease in short- and long-term mortality.
Dr Lara Harvey, NeuRA senior research fellow and lead author, said hip fracture is common and associated with substantial morbidity, mortality, reduced quality of life and independence.
She said a quarter of people die within one year of their fracture, another 50% do not regain their previous level of function, and for 11% the fracture results in a new placement in aged care.
“This research showed mortality risk dropped significantly with orthogeriatric care, having surgery within 48 hours of presentation, being offered the ability to mobilise on the day-of or day-after surgery, and receiving bone protection medication prior to discharge,” she said.
The Hip Fracture Clinical Care Standard was introduced by the Australian Commission on Safety and Quality in Health Care in 2016 to improve care for around 19,000 people who fracture their hip each year, usually after a fall. It was updated in 2023.
The standard outlines seven key quality indicators including:
- Care at presentation
- Pain management
- Orthogeriatric model of care
- Timing of surgery
- Mobilisation and weight bearing
- Minimising the risk of another fracture
- Transition from hospital
Researchers analysed data from the Australian and New Zealand Hip Fracture Registry, hospital, residential aged care facility and death records to explore the impact of the standard in improving outcomes for patients.
They found where patients received care that met five or six of the key quality indicators there was a 60% decreased risk of 30-day mortality.
Those who received care with moderate adherence to the quality indicators had a 40% decreased risk. This pattern was sustained at one year.
“These findings emphasise the significant cumulative impact of adhering to multiple care processes and underscore the importance of a multidisciplinary approach to delivering high-quality hip fracture care,” Dr Harvey said.
“We would like to see more patients continue to receive this high level of care in line with the standard.”
The Australian and New Zealand Hip Fracture Registry’s annual report, released this month, also focused on performance in hip fracture care against the standard.
Professor Jacqueline Close, registry co-chair and NeuRA Senior Principal Research Fellow, said that while initiation of treatment for osteoporosis has improved this year, the rate remained poor, and many people left hospital without treatment that could reduce the risk of future fractures.
“We still face challenges in ensuring people get timely access to surgery and more work needs to be done in getting people out of bed and up on their feet the day after surgery – both of these indicators are strongly linked to better outcomes for patients.”
She added that the paper in the MJA provides an important message to all hospitals.
“We know that many hospitals do one or two things well, but the real benefits to our patients are when we do all of it well.”
https://anzhfr.org/registry-reports/