The hip fracture quality improvement programme (HipQIP) scaling up project is a multi-centre quality improvement collaborative funded by the Health Foundation and led by Northumbria Healthcare NHS Foundation Trust. It is focused on improving care and outcomes for people presenting to hospital with a fragility hip fracture.
The challenge
Hip fracture is the most common serious injury for older people and the most common reason for them to need emergency surgery. Emergency hip fracture care costs the NHS more than £1 billion a year and length of hospital stay represents the largest portion of the cost. Patients may remain in hospital for several weeks, occupying around 1.5 million bed days each year, equating to the continuous occupation of more than 3,600 NHS beds across England, Wales and Northern Ireland.
Quality improvement
A decade of evidence from the National Hip Fracture Database (NHFD) has shown how the Hip Fracture Programmes recommended by NICE improve the quality and outcome of care.
Aims
The quality improvement aims of the HipQIP scaling up project were to:
- Provide hip fracture care of the highest quality
- Introduce a pathway approach that ensures consistent care
- Ensure that recent evidence and national standards are systematically implemented
- Provide exceptional patient experience – meeting physical, emotional and information needs.
Objectives
Central to these aims were a number of specific objectives:
- More lives saved with safer and best practice care
- More lives saved through increasing nutritional support after surgery
- More lives saved with access to surgery within 36 hours
- More lives saved with patients supported to mobilise as early as possible after surgery
- Better access to specialist care for elderly patients with complex medical problems
- Better access to information to enable patients to manage their own care
- Better access to guidance that helps patients know what good care looks like
- Better pain management.
Project evaluation
The evaluation of the HipQIP scaling up project, alongside provision of ongoing formative data to collaborative sites and the Northumbria project team, was undertaken by the Falls and Fragility Fracture Audit Programme (FFFAP) team.
The Falls and Fragility Fracture Audit Programme (FFFAP) is a national clinical audit programme commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). FFFAP is managed by the Care Quality Improvement Department (CQID) of the Royal College of Physicians (RCP).
Clinical leadership for this evaluation was provided by Dr Antony Johansen – an experienced clinician with two decades leading clinical audit in this field, who has co-led the NHFD since 2013.