National Hip Fracture Database Anaesthesia Sprint Audit of Practice (ASAP) report 2014

The outcome of hip fracture serves as a key marker of the quality of hospital care across the many disciplines and departments who collaborate before, during and after this operation. However, the immediate physiological stress experienced by these patients is the pain and blood loss associated with the fracture. High quality anaesthetic care is crucial to the effective management of both stresses. Clinicians interested in promoting better anaesthetic management of patients with hip fracture came together in 2007. The Hip Fracture Perioperative Network (HipPeN) grew from this, and produced a report in 2010 highlighting wide variations in anaesthetic practice. HipPeN has since completed several projects – leading to publication of the Association of Anaesthetists of Great Britain and Ireland (AAGB&I) guidelines on the anaesthetic management of hip fracture in 2012. The National Hip Fracture Database (NHFD) is the largest hip fracture database in the world. The database includes surgical and mortality data on a third of a million patients. It captures 95% of all new cases of hip fracture, with data from all hospitals in England, Wales, Northern Ireland and the Channel Islands, and provides an ideal infrastructure for large audits. Public funding was provided through the Healthcare Quality Improvement Partnership (HQIP); the NHFD has now been incorporated into the Falls and Fragility Fracture Audit Programme (FFFAP) administered by the Royal College of Physicians (RCP). Collaboration between the AAGB&I and the NHFD culminated in this 2014 report which profiles approaches to peri-operative care across England, Wales and Northern Ireland. ASAP set out to collect data on everyone over the age of 60 who had hip fracture surgery in hospitals across England, Wales and Northern Ireland between 1st May and 31st July 2013. The aim of ASAP was to profile individual hospitals’ compliance with the standards for peri-operative care defined by the National Institute of Health and Care Excellence (NICE) in 2011, and the Association of Anaesthetists of Great Britain and Ireland (AAGB&I) in 2012. The audit covers England, Wales, Northern Ireland, the Isle of Man and the Channel Islands, however data files only refer to data for England.