Abstract
To evaluate the performance of this institution in its delivery of care to elderly patients with a hip fracture over an 11-year period and to establish recommendations to improve practice.
Regular prospective audits of a cohort of 50 patients have been undertaken between 1990 and 2000. A larger and more comprehensive retrospective audit of 100 patients was performed in 2001. Goals were set regarding time to admission, time to surgery and to discharge in close accordance with the best practice guidelines devised by the Royal College of Physicians in 1989.
There has been an alarming decline in standards in key areas.
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Time from A& E to admission: at best 78% of patients within 3 hours, 4% in 2001.
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Time from admission to surgery: at best 89% within 24 hours, 31% in 2001.
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Persistence of significant morbidity for patients delayed to surgery for non-medical reasons: 65% of these patients developed a post operative complication and 20% died within 30 days of admission.
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Delay to discharge: at best 13 acute bed days, now 18 (2001).
Current practice is less than ideal. Clinical governance involves a dual responsibility – of the clinician to maintain high standards and of the management to provide adequate resources. Both need addressing to reverse the current trend.
The abstracts were prepared by Mr Tim Briggs. (Editoral Secretary 2003/4) Correspondence should be addressed to him at Lane Farm, Chapel Lane, Totternhoe, Dunstable, Bedfordshire LU6 2BZ, United Kingdom
