Hip fracture patients face lethal luck of draw

Risk of dying is twice as high in some hospitals as researchers say elderly care must improve

‘Hip patients should expect the same high-quality care irrespective of which hospital they attend’

HIP fracture patients are more than twice as likely to die at some hospitals than others, a study has found.

The proportion of elderly patients who die within 30 days of breaking their hip varies from 3.7 per cent in some hospitals to 10 per cent in others, a University of Bristol research shows.

The average length of hospital stay is just 12 days in some units in England and Wales compared with 42 days in others. Meanwhile, the odds of being readmitted for more care vary from 3.7 per cent to 30 per cent, the study found.

Deborah Alsina, chief executive of Versus Arthritis, which funded the study, said: “This research highlights the worrying state of care for older people who break their hip.

“The findings show that older people have a high chance of dying in the weeks after breaking a hip, and that whether or not they survive varies enormously between NHS hospitals in England and Wales.

“Hip fractures mainly affect older people, many of whom live with multiple long-term conditions, and quality of care for people with hip fractures is a key indicator of whether we’re getting older people’s care right in general. This research suggests we are not.”

Each year, more than 70,000 people are admitted to hospital with a hip fracture in the UK.

Researchers examined all cases in England and Wales involving those aged over 60 between April 2016 and March 2019.

Researchers identified various factors that meant hospitals were more or less likely to have poorer outcomes.

Hospitals with more orthopaedic specialists saw their patients sent home sooner on average and these trusts were also less likely to see people readmitted for further treatment.

Patients encouraged to get out of bed on the first day after surgery also had shorter spells on a ward.

Hospitals that were able to provide surgery within 36 hours of admission saw a 10 per cent reduced risk in patients dying within 30 days.

Hospitals with busier emergency departments saw a higher rate of patients being readmitted.

The researchers found that how well patients recovered after a hip fracture varied hugely between the 172 hospitals studied. The research team found 41 different ways in which hospitals delivered care that were linked to patient outcomes.

They said many of the differences could be changed, providing the potential to improve patient outcomes and reduce the variability in how services are delivered between hospitals.

It is estimated 890 excess readmissions might be avoided each year in England and Wales if all hospitals addressed delays between discharge and initiation of community therapy.

Celia Gregson, professor in clinical epidemiology in the Musculoskeletal Research Unit at Bristol University, said: “Patients should be able to expect to receive the same, high-quality care if they break their hip, irrespective of where they live or which hospital they attend. The results of our study have shown multiple, important points in the pathway of patient care which hospitals can focus on to streamline and improve the quality of their hip fracture services and patient outcomes.”

Prof Antony Johansen, clinical lead for the National Hip Fracture Database and an author on the study, added: “It’s vital that hospitals have enough staff – nurses and physiotherapists – so they can help patients get back on their feet quickly after a hip fracture. Otherwise, patients will lose their independence and may even lose the will to recover.”

The study was published in the journal Age and Ageing.