Hip fracture audit: the Nottingham experience

The hip fracture audit in Nottingham started in May 1999. Using our data, we have developed the Nottingham Hip Fracture score and are able to predict long-term survival. High quality data collection is best achieved by trained staff dedicated to data collection and analysis. We have found it very cost-effective to train audit clerks in basic data analysis and statistical techniques, allowing for rapid analysis of data. We have developed a pre-operative scoring system to predict 30-day mortality for patients undergoing hip fracture surgery and the score is calculated for all patients over 65 years. In 2008, our audit data were used to assess mortality associated with hip fractures in the geriatric population at 5 years, and to identify the influence of pre-operative age, cognitive state, mobility and residential status on long-term survival. This study allows us to identify patients with a higher chance of long-term survival and consider surgical management that may provide a better long-term outcome. The prevalence of hip fracture in our population has steadily increased over the past decade and we are able to report a fall in the 30-day mortality and the 1-year mortality with time. Using the Nottingham Hip Fracture score which identifies patients pre-operatively that are at high risk of mortality has proved extremely useful in clinical practise. The United Kingdom National Hip Fracture Database was established in 2007 to improve the quality and cost-effectiveness of care for hip fracture patients. Variation in quality of care should be reduced between units and best practise adopted throughout the health service.