Key points
- NeuRA researchers have found that adherence to hip fracture care standards reduces patient mortality.
- Where patients received hip fracture care that met five or six out of six key quality indicators, they had a 60% lower short-term mortality risk, while those meeting four indicators saw a 40% reduction.
- However, a third of hip fracture patients are still not receiving care with a high level of adherence to the indicators, highlighting there is room for improvement in hip fracture care.
- Based at NeuRA, the Australian New Zealand Hip Fracture Registry continues to grow and now has data on more than 110,000 hip fractures.
Hip fractures are common and their impact can be substantial, but researchers have found that adhering to clinical care standards reduces the risk of death and significantly improves patient outcomes.
The Medical Journal of Australia has published a report, led by NeuRA Senior Research Fellow, Lara Harvey, that showed the Hip Fracture Care Clinical Standard is improving outcomes for patients, with some factors substantially lowering risk of death for patients.
“What this research found was that if hip fracture patients received high quality clinical care, there is a significant decrease in short- and longer-term mortality,” Dr Harvey said.
“Hip fracture is common and unfortunately associated with substantial morbidity, mortality, reduced quality of life and independence. 25% of people die within one year of their fracture, a further 50% don’t regain their previous level of function and, for 11%, that 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.”
Clinical standards critical to patient outcomes
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.
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 Hip Fracture Care Clinical Care Standard in improving outcomes for patients. The results were published as “Adherence to clinical care standards and mortality after hip fracture surgery in NSW, 2015-18: a retrospective population-based study”.
“This study showed that where patients received care in line with the Hip Fracture Clinical Care Standard, there were significant improvements to their outcomes,” Dr Harvey said.
The study found where patients received care that met five or six out of six key quality indicators there was a 60% decreased risk of 30-day mortality, while 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, which was updated last year.”
Hip Fracture Registry finds care improving, but more to be done
The Australian and New Zealand Hip Fracture Registry (ANZHFR) Annual Report 2024 released this month found an ongoing increase in participation of the registry, noting both achievements and areas requiring work.
Professor Jacqueline Close AM, Co-Chair of the ANZHFR and NeuRA Senior Principal Research Fellow, said the 9th annual report had a focus on performance against the clinical care standard.
“We’re seeing improvement in preoperative assessment of cognition and delirium and the use of nerve blocks prior to surgery,” Prof Close said.
“Whilst initiation of treatment for osteoporosis has improved this year, the rate remains poor and many people leave hospital without treatment that we know can 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.
“The paper released today in the Medical Journal of Australia 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.”
ANZHFR Co-Chair, Associate Professor Chris Wall, said the trans-Tasman registry has data on more than 110,000 hip fractures and continues to grow.
“The Registry continues to grow as a platform for clinical research, practice development and to support clinicians and researchers,” he said.
“All eligible New Zealand hospitals are contributing to the Registry, but at this stage that’s not the case in Australia.”
Chief Medical Officer for the Australian Commission on Safety and Quality in Health Care, emergency physician Associate Professor Carolyn Hullick, said the Standard was developed to reduce serious outcomes from a hip fracture.
“The Registry’s research demonstrates that standards of care work in the interest of patients,” she said.
“The Commission commends the Registry for their vital work in leading improvements in the quality of hip fracture care.”
The Hip Fracture Care Clinical Care Standard was revised in late 2023, and reporting of new indicators in the ANZHFR Annual Report will commence from next year.
To read more about how the Hip Fracture Care Clinical Care Standard is improving mortality, visit: https://www.mja.com.au/journal/2024/221/9/adherence-clinical-care-standards-and-mortality-after-hip-fracture-surgery-new
To read the ANZHFR 2024 Annual Report, visit: https://anzhfr.org/registry-reports/
Some statistics:
Of Australian hip fracture patients in 2023
- The average age was 81 years old
- 66% were female
- 46% walked without a walking aid prior to their injury
During their care:
- 67% had a documented assessment of pain within 30 minutes of arrival at the ED
- 78% had a preoperative assessment of cognition
- 83% had a nerve block to manage pain before surgery
- 87% were seen by a geriatrician during their acute hospital stay
- 77% had surgery within 48 hours
- 46% achieved first day walking
After treatment:
- 33% were on active treatment for osteoporosis at discharge
- 80% who were followed up at 120 days had returned to their own home
About us:
Neuroscience Research Australia (NeuRA) is an independent, not-for-profit research institute based in Sydney aiming to prevent, treat and cure brain and nervous system diseases, disorders and injuries through medical research.
To learn more about NeuRA: www.neura.edu.au
