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Fitzgerald M1, Blake C2, Brent L3, Hurson C4, Ahern E5, Callnanan E6, Cunningham C2
1Tallaght Hospital, Physiotherapy, Dublin, Ireland, 2University College Dublin, Physiotherapy, Dublin, Ireland, 3National Office for Clinical Audit, National Office fro Clinical Audit, Dublin, Ireland, 4St Vincent's University Hospital, Orthopaedics, Dublin, Ireland, 5St Luke's Hospital, Geriatric Medicine, Kilkenny, Ireland, 6Merlin Park Hospital, Physiotherapy, Galway, Ireland
Background: Functional outcomes post hip fracture are poor, despite recent advances in hip fracture care standards. Rehabilitation remains a central challenge in trauma services. A key factor in improving hip fracture outcome is the implementation of national hip fracture databases, which allow health services to monitor care standards. New rehabilitation focussed data-fields were added to the Irish Hip Fracture Database (IHFD) on 1st January 2016 with the aim of providing information regarding hip fracture physiotherapy service provision and functional outcome across all acute trauma orthopaedic units in Ireland.
Purpose: To provide a national profile of service provision and functional mobiility outcome post hip fracture in Ireland.
Methods: The IHFD is a clinically-led, national web based audit of hip fracture casemix, care and outcomes. The IHFD has been recording data since 2012, with new rehabilitation-focussed data-fields added on 1stJanuary 2016. Data are collected through the hospital inpatient enquiry (HIPE) portal in collaboration with the Healthcare Pricing Office (HPO). The National Office of Clinical Audit (NOCA) provides operation governance for the IHFD. The new rehabilitation data-fields include:
· Day one postoperative physiotherapy assessment:Yes/No
· Day one postoperative mobilisation:Yes/No
· Pre-fracture function:New Mobility Score (NMS)
· Function on first postoperative day and acute hospital discharge:Cumulated Ambulatory Score (CAS).
Results: The 2016 IHFD report comprises data of 3,629 hip fracture patients in Ireland from all 16 acute trauma orthopaedic units. The New Mobility Score was captured for 93% (n=2383) of patients, with 48% of having high pre-fracture function (NMS ≥7). 78% of patients (n=2325) were assessed on the day of or day after surgery by a physiotherapist, with 71% mobilised by a physiotherapist. CAS was captured for 50% (n=1829) of patients on the first postoperative day and 36% (n=1307) of patients on acute hospital discharge. Of those patients, 92% required assistance in their basic mobility (CAS≤3) on the first postoperative day, with 18% achieving independence (CAS=6) on discharge.
Conclusion(s): Over 75% of hip fracture patients in Ireland are assessed by a Physiotherapist Day 1 post surgery. !8% of patients achieve independent walking prior to discharge for the acute setting. Both the CAS and NMS are feasible measures of mobility for use in the acute hospital setting post hip fracture.
Implications: These new data enable profiling of both physiotherapy service provision and functional outcome post hip fracture in Ireland. With continued commitment to data collection quality and extension of the IHFD data collection time-frames beyond the acute hospital setting, it will be possible to identify barriers to rehabilitation and evaluate the impact of organisations improvements in hip fracture care delivery on functional outcome.
Keywords: hip fracture, mobility, database
Funding acknowledgements: none
Purpose: To provide a national profile of service provision and functional mobiility outcome post hip fracture in Ireland.
Methods: The IHFD is a clinically-led, national web based audit of hip fracture casemix, care and outcomes. The IHFD has been recording data since 2012, with new rehabilitation-focussed data-fields added on 1stJanuary 2016. Data are collected through the hospital inpatient enquiry (HIPE) portal in collaboration with the Healthcare Pricing Office (HPO). The National Office of Clinical Audit (NOCA) provides operation governance for the IHFD. The new rehabilitation data-fields include:
· Day one postoperative physiotherapy assessment:Yes/No
· Day one postoperative mobilisation:Yes/No
· Pre-fracture function:New Mobility Score (NMS)
· Function on first postoperative day and acute hospital discharge:Cumulated Ambulatory Score (CAS).
Results: The 2016 IHFD report comprises data of 3,629 hip fracture patients in Ireland from all 16 acute trauma orthopaedic units. The New Mobility Score was captured for 93% (n=2383) of patients, with 48% of having high pre-fracture function (NMS ≥7). 78% of patients (n=2325) were assessed on the day of or day after surgery by a physiotherapist, with 71% mobilised by a physiotherapist. CAS was captured for 50% (n=1829) of patients on the first postoperative day and 36% (n=1307) of patients on acute hospital discharge. Of those patients, 92% required assistance in their basic mobility (CAS≤3) on the first postoperative day, with 18% achieving independence (CAS=6) on discharge.
Conclusion(s): Over 75% of hip fracture patients in Ireland are assessed by a Physiotherapist Day 1 post surgery. !8% of patients achieve independent walking prior to discharge for the acute setting. Both the CAS and NMS are feasible measures of mobility for use in the acute hospital setting post hip fracture.
Implications: These new data enable profiling of both physiotherapy service provision and functional outcome post hip fracture in Ireland. With continued commitment to data collection quality and extension of the IHFD data collection time-frames beyond the acute hospital setting, it will be possible to identify barriers to rehabilitation and evaluate the impact of organisations improvements in hip fracture care delivery on functional outcome.
Keywords: hip fracture, mobility, database
Funding acknowledgements: none
Topic: Orthopaedics; Outcome measurement; Service delivery/emerging roles
Ethics approval required: No
Institution: Health Services Executive
Ethics committee: Health Services Executive
Reason not required: Considered as audit - anonymised data
All authors, affiliations and abstracts have been published as submitted.
