National Hip Fracture Database Network
The National Hip Fracture Database (NHFD) and the 2nd Edition of the Blue book on the care of patients with fragility fractures are examples of a burgeoning spirit of collaboration between the British Orthopaedic Association (BOA) and the British Geriatrics Society (BGS), as a response to this massive public health threat. They share the same goals: to ensure that every patient presenting with a hip fracture receives excellent all-round medical care and rehabilitation, despite their many comorbidities; excellent surgery, despite the challenges of osteoporotic bone and reliable and effective secondary prevention, i.e. treatment of underlying osteoporosis or tendency to fall.
The NHFD and Blue Book were launched together on 19th September 2007, with good coverage in television, print and web-based media. That coverage clearly grasped the rationale for a systematic approach to improving fracture care and secondary prevention of fracture; and how this would be supported by continuous audit and quality improvement via the NHFD.
NHFD was developed and launched with generous funding from industry via the ABPI and ABHI amounting to £300K. It was envisaged that by mid-2008 the success of the NHFD would have resulted in a transition to funding from central NHS sources. However, major organizational uncertainties affecting the Healthcare Commission have resulted in a hiatus in the funding for national audit programmes.
Happily though, the potential of the NHFD in the improvement of hip fracture care and secondary prevention has been recognised by a substantial award of £120k from DoH sources to develop the database further. We are confident we can attract permanent central funding from the Healthcare Commission when it becomes available.
The NHFD is led by an executive committee consisting of four people each nominated by the British Orthopaedic Association and the Trustees of the British Geriatric Society. They are David Marsh (Chairman), Rob Wakeman, Hamish Simpson and Chris Moran from the BOA and Finbarr Martin, Colin Currie, Jonathan Potter and Opinder Sahota from the BGS. A representative from the Royal College of Nursing, Karen Hertz, Project Manager, Maggie Partridge and Project Coordinator, Bev Vaughan completes the team.
A preliminary database of more than 11,500 cases has been established using data from existing audits. The latest report shows that 16 fracture units have commenced uploading cases, with a further 5,965 cases from existing audits and 1100 new cases documented since launch. It is particularly encouraging that this rate of recruitment of hospitals and cases already exceeds that of MINAP (the highly successful Myocardial Infarction National Audit Project) at the same stage in its development. A further 44 hospitals have registered with the NHFD with the intention of uploading data, this number representing over 33% of those eligible. Recruitment continues, via individual approaches from fracture units, outreach meetings organised by NHFD staff, and presentations at relevant national meetings of specialist societies: e.g. BGS (Harrogate) and NOS (Edinburgh), both in November. Our ultimate goal is to have every hospital in the UK sign up to participate in the database.
A model emerging as a strong contender for delivering both the Blue Book objectives and the NHFD data capture, is to have specialist nurses working in the fracture wards in an elderly trauma coordinator role, supported by consultant orthogeriatricians. We are working with the Society of Orthopaedic and Trauma Nursing - part of the RCN - to further this idea. We believe that the data collected for the NHFD will be valuable in arguing for improved resources from Trusts and along with improved quality of care leading to reduced length of stay - the role will pay for itself.
We have a long way to go - but we are getting there!
To learn more about the NHFD and the Blue Book on the care of patients with fragility fractures please visit our website.
Network website: www.nhfd.co.uk
Network co-ordinators: Maggie Partridge, maggie.fractures@ucl.ac.uk, tel. 020 8909 5303, mob. 07876 163 525
Bev Vaughan, bev@nhfd.co.uk, tel. 020 7251 8868, mob. 079122 02953