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Hip fracture: the case for a funded national registry

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Let’s implement what we know and avoid deaths from hip fracture

The value of orthogeriatric care for hip fracture patients has been known for years, and a recent summary of international evidence has acknowledged the benefits.1 The NHS in England considered this so important that it offers serious financial incentives for hospitals to achieve an evidence-based standard of care — a “best-practice tariff” rewards hospitals that achieve the following key quality criteria:

  • surgery within 36 hours
  • shared care by surgeon and geriatrician
  • care protocol agreed to by geriatrician, surgeon and anaesthetist
  • assessment by geriatrician within 72 hours of admission
  • preoperative and postoperative abbreviated mental test score assessment
  • geriatrician-led multidisciplinary rehabilitation
  • secondary prevention of falls
  • bone health assessment.2

This incentive, together with the United Kingdom’s long established National Hip Fracture Database, has enabled monitoring of care and tracking of definite improvements.3 Hospitals are identified in the UK audit, so the poor performers cannot hide; this provides additional incentive to get things right.

Orthogeriatric care is not particularly complex. Like much of geriatric medicine, it is about…