A new report today by the Royal College of Physicians (RCP) shows dramatic results of an innovative programme of screening for delirium which has been the focus of attention and investment through NHS England’s best practice tariff.
The RCP’s National Hip Fracture Database (NHFD) has championed the routine assessment of people to identify, prevent and treat such problems, and over 80% of all patients received such assessment in 2017. Delirium is the commonest complication of hip fracture, and of the anaesthesia and surgery necessary to treat this injury.
The NHFD’s annual report shows that a quarter of all patients were identified as having delirium after surgery. Such patients were twice as likely to die in hospital, and four times more likely to need to move to live in a nursing home – a result that most fear more than dying.
Delirium can take the form of sudden confusion, drowsiness or agitation, and can be a terrifying experience for frail older patients and their families.
Hip fracture is the commonest reason for older people to need emergency anaesthesia and surgery, and the commonest cause of accidental death. Patients may remain in hospital for a number of weeks, and at any one time patients recovering from hip fracture occupy over 3,600 hospital beds in England, Wales and Northern Ireland.
Iona Price, Chair of Patient Panel for the RCP’s Falls and Fragility Fracture Audit Programme, said:
Following surgery for a hip fracture my mother experienced delirium. Due to her confused state of mind her length of stay on the acute ward was prolonged and her rehabilitation programme halted. When eventually discharged my mother was considered too immobile to return to her care home and instead moved to a nursing home.
Delirium is extremely traumatic and distressing for both the patient and their loved ones. It is incredibly difficult to see someone you love so confused and upset. Delirium can significantly limit the level of recovery an individual might achieve. I am delighted that the NHFD has been championing screening for delirium with such positive results.
Dr Antony Johansen, Consultant geriatrician and NHFD clinical lead, said:
It is truly heartening to see orthopaedic teams taking this lead in trying to prevent and address a complication that is such a devastating, distressing experience for patients and their families. Other surgical services should consider similar approaches to improve the care of their own patients.
Mr Dominic Inman, Consultant trauma and orthopaedic surgeon and NHFD clinical lead, said:
The importance of early recognition or avoidance of delirium could go a long way to improving patient outcome, survival and quality of life after hip fracture. I urge trusts to use this report to examine areas where they can improve their performance. This can be achieved by focusing on key elements of the patient pathway such as nutritional support, early pain assessment and management, prompt surgery in line with NICE guidance and working to help patients get up and walking as soon as possible following their surgery for a broken hip.
For more information or to arrange an interview please contact Amarinder Cooner, RCP Care Quality Improvement Department communications adviser, on +44 (0)20 3075 2399.
About the National Hip Fracture Database (NHFD)
The National Hip Fracture Database (NHFD) is a clinically led, web-based quality improvement initiative managed by the Royal College of Physicians (RCP). The NHFD was founded by the British Orthopaedic Association and the British Geriatrics Society between 2004 and 2007. It has collected data since 2007. In 2012 the NHFD moved to be managed as part of the Falls and Fragility Fracture Audit Programme (FFFAP) within RCP London.
The NHFD is run by the Royal College of Physicians. Since it was established in 2007 the NHFD has presided over a progressive improvement in the quality and outcome of hip fracture.
The NHFD documents major innovations in collaborative working between orthopaedic surgeons and geriatricians which drive improved care for patients requiring emergency hip fracture surgery. Its annual report collates this data.