Significant variation in hip fracture care persists

Improvements in geriatric assessments made but lack of delirium screening raises concerns

Tuesday 20th August 2019

The latest audit of hip fractures in Scotland shows progress has been made in several areas including reduced hospital stays but deficiencies elsewhere – including in delirium screening – remain.

In 2018, 86% of hip fracture patients admitted to emergency departments were transferred to an orthopaedic ward within the four hour target time.

57% of patients were in theatre within 24 hours of hospital admission, an increase from 55% the previous year, while the length of stay for patients continued to improve steadily, falling from 22 days in 2017 to 17 days in 2018.

The report notes: ‘One of the greatest achievements of the audit has been the improvement in ortho-geriatric provision with almost 85% of patients now undergoing review within 72 hours of admission from less than 20% at the introduction of the audit.’

However, it goes on to state: ‘It is clear that there remains significant variation in achievement of each standard across the country and improving on this will continue to be a major focus of the audit’.

Commenting on the findings, Dr Sue Pound, geriatrician and vice-president of the Royal College of Physicians of Edinburgh (RCPE) said:

We are encouraged that 84% of Scottish patients identified locally as frail had a comprehensive geriatric assessment within three days of a hip fracture admission in 2018.

This figure is improving year on year, although some parts of the country are unfortunately lagging behind the national average.

A comprehensive geriatric assessment is important for frail patients, because it can help identify an older person's functional ability, physical health, cognition and mental health, and circumstances.

Evidence shows that a comprehensive geriatric assessment increases someone’s likelihood of recovering and being in their own home after an emergency admission to hospital.”

However, a ‘reversal in the significant progress made’ in some areas such as delirium screening is noted in the report.  

An extremely common condition among hospital patients, delirium is a deterioration in mental function affecting 20-30% of people on medical wards, 10-50% of people having surgery and 75% of patients in intensive care units.

The onset is often rapid, with symptoms including severe drowsiness, agitation and hallucinations, and can last for days, or even weeks or months.

Dr Pound added: “We also note that the proportion of patients who had delirium screening in Scottish emergency departments remains under 60% nationally – and it is particularly notable that three out of 19 Scottish hospitals almost never completed delirium screening.

Delirium is extremely common in people who have suffered a hip fracture, and it is associated with significant morbidity and mortality.

Early detection is important to ensure timely intervention and management of this very distressing condition for older patients.”