Audit of hip fractures and standards of care in Brunei Darussalam
Keywords:
Elderly, hip fracture, Orthogeriatrics, osteoporosis, rehabilitationAbstract
Background: Hip fractures in the elderly are associated with poor outcomes, including impaired mobility, function, quality of life, medical complications and mortality. Standards of care have been developed to improve the outcomes of hip fracture patients.
Objective: The purpose of the study was to audit the efficiency of admission to acute orthopaedic ward and time to surgery, whether hip fracture patients needed much medical input and if patients were evaluated for fall and fracture prevention.
Methods: Orthopaedic patients admitted with a hip fracture between January 2014 and December 2014 were recruited. Electronic clinical records were reviewed for data extraction and analyzed.
Results: There were 56 patients admitted with the audit done on 31 consecutive patients. Median age was 80 years (range 60 - 94 years), with two-thirds being female. Timely admissions to orthopaedic ward and time to surgery was completed in 11 (35.5%) and 4.3%, respectively. There were 8 (25.8%) of patients managed conservatively without surgery. Two-thirds of the patients required medical review. Approximately half of them did not have adequate history taken concerning their previous falls, with almost 40.0% had no documentation regarding how the patients fell. Orthostatic blood pressure was not checked for any of the patients. Half of the patients did not receive occupational therapy input, which is necessary for assessment of environmental fall risk. As for 87.0% of the patients, there were no documented plans regarding anti-resorptive therapy. The hip fracture patients had poor mobility outcomes and a prolonged length of stay. Since the audit was completed, an orthogeriatric liaison service was initiated to attempt to improve hip fracture outcomes.
Conclusion: Patients with hip fractures require timely admissions and surgery, medical review to optimize their health pre-operatively, assessment for falls and fracture risk and are at risk of poor functional outcomes.
