File
ten Hove R1, White P1, Johansen A2
1Chartered Society of Physiotherapy, Practice and Development, London, United Kingdom, 2Royal College of Physicians, London, United Kingdom
Background: Hip fracture anaesthesia and surgery are now so successful that nearly all patients will get out of bed by the day after operation. However, their subsequent recovery of mobility and independence depends on the quality of care provided by the multidisciplinary team.
Purpose: The focus of work following the publication of the Hipsprint national audit of physiotherapy following hip fracture, is to:
- reduce variation across the patient pathway
- improve the patient experience of physiotherapy
- Ensure the strong engagement of physiotherapists within the hip fracture programme.
Methods: In May-October 2017 the Chartered Society of Physiotherapy (CSP) led work by >580 physiotherapists - providing data for 5,989 (78.6%) of the 7,621 people who the National Hip Fracture Database recorded in 127 hospitals. We recorded therapy each day in the week after surgery, and in any subsequent ward, community or home rehabilitation placement.
Results: Half (48.6%) of those admitted from home returned there directly from the acute ward.
Patients averaged 118 minutes of physiotherapy in the first week, but wards which provided more were more likely to get patients up by the day after surgery (69.1% vs. 67.8, p 0.05) and returned more patients straight home (50.3% vs. 47.3%, p 0.05). Hip Sprint identified We also identified weakness in early mobilisation, the intensity of rehabilitation, the quality of handover and continuity between care providers (including a gap between discharge and start of community rehabilitation that averaged 15.2 days, and was >30 days in five units) and in physiotherapists' engagement in clinical governance. These weaknesses were discussed by a group including specialist physiotherapists and patient representatives.
Conclusion(s): Seven standards for improving the quality of physiotherapy following hip fracture have been developed, consulted on widely and agreed
1. A physiotherapist assesses all patients on the day of or day following hip fracture surgery
2. All patients are mobilised on the day of or day following hip fracture surgery.
3. All patients receive daily physiotherapy that should equal at least two hours in the first 7 days post-surgery.
4. All patients receive at least two hours of rehabilitation in subsequent weeks post-surgery, until individual goals are achieved.
5. All patients moving from hospital to the next phase of rehabilitation are seen by their new care provider within 72 hours.
6. A physiotherapist is part of every Hip Fracture Programme's monthly clinical governance meeting.
7. Physiotherapists share their assessment findings and rehabilitation plans with all rehabilitation providers to enable clear communication with the MDT.
Implications: We believe that that these standards will help focus clinical teams' and health managers' attention on areas of practice that have the greatest potential to improve patients' experience and outcome.
Keywords: hip fracture, standards, improvment
Funding acknowledgements: This work was funded by the Chartered Society of Physiotherapy
Purpose: The focus of work following the publication of the Hipsprint national audit of physiotherapy following hip fracture, is to:
- reduce variation across the patient pathway
- improve the patient experience of physiotherapy
- Ensure the strong engagement of physiotherapists within the hip fracture programme.
Methods: In May-October 2017 the Chartered Society of Physiotherapy (CSP) led work by >580 physiotherapists - providing data for 5,989 (78.6%) of the 7,621 people who the National Hip Fracture Database recorded in 127 hospitals. We recorded therapy each day in the week after surgery, and in any subsequent ward, community or home rehabilitation placement.
Results: Half (48.6%) of those admitted from home returned there directly from the acute ward.
Patients averaged 118 minutes of physiotherapy in the first week, but wards which provided more were more likely to get patients up by the day after surgery (69.1% vs. 67.8, p 0.05) and returned more patients straight home (50.3% vs. 47.3%, p 0.05). Hip Sprint identified We also identified weakness in early mobilisation, the intensity of rehabilitation, the quality of handover and continuity between care providers (including a gap between discharge and start of community rehabilitation that averaged 15.2 days, and was >30 days in five units) and in physiotherapists' engagement in clinical governance. These weaknesses were discussed by a group including specialist physiotherapists and patient representatives.
Conclusion(s): Seven standards for improving the quality of physiotherapy following hip fracture have been developed, consulted on widely and agreed
1. A physiotherapist assesses all patients on the day of or day following hip fracture surgery
2. All patients are mobilised on the day of or day following hip fracture surgery.
3. All patients receive daily physiotherapy that should equal at least two hours in the first 7 days post-surgery.
4. All patients receive at least two hours of rehabilitation in subsequent weeks post-surgery, until individual goals are achieved.
5. All patients moving from hospital to the next phase of rehabilitation are seen by their new care provider within 72 hours.
6. A physiotherapist is part of every Hip Fracture Programme's monthly clinical governance meeting.
7. Physiotherapists share their assessment findings and rehabilitation plans with all rehabilitation providers to enable clear communication with the MDT.
Implications: We believe that that these standards will help focus clinical teams' and health managers' attention on areas of practice that have the greatest potential to improve patients' experience and outcome.
Keywords: hip fracture, standards, improvment
Funding acknowledgements: This work was funded by the Chartered Society of Physiotherapy
Topic: Older people
Ethics approval required: No
Institution: Royal College of Physicians
Ethics committee: Falls and Fragility Fracture Audit Programme
Reason not required: the Hip Sprint audit was undertaken as part of the national audit of hip fracture patients in the NHS. Approvals were agreed through that programme
All authors, affiliations and abstracts have been published as submitted.
