NHFD Report 2013 PDF

National Hip Fracture Database

National report 2013
National Hip
Fracture Database
Prepared on behalf of the Clinical Effectiveness
and Evaluation Unit at the Royal College of Physicians
This report was prepared by the members of the workstream

delivery team
Antony Johansen, NHFD clinical lead, orthogeriatric medicine
Rob Wakeman, NHFD clinical lead, orthopaedic surgery
Chris Boulton, NHFD project manager
Fay Plant, NHFD project coordinator
Jonathan Roberts, web developer
Andy Williams, NHFD project coordinator
Data analysis and chart production by
Quantics Consulting Ltd,
www.quantics.co.uk
Speed search for your hospitals results:
Go to Edit at the top of the report then Find.
Type in your hospital code
The code will be highlighted wherever it appears in the report.
Brief extracts from this publication may be reproduced provided the
source is fully acknowledged.
Enquiries and comments about this report would be welcomed.
Please contact:
NHFD, Falls and Fragility Fracture Audit Programme,
Royal College of Physicians,
11 St. Andrews Place,
Regents Park,
London. NW1 4LE
A summary of this report is also available online
www.nhfd.co.uk
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Copyright National Hip Fracture Database 2013. All rights reserved.

CONTENTS
Executive summary...................................................................................................................... 45
Introduction.............................................................................................................................. 615
Participating hospitals............................................................................................................. 1617
Completeness of data fields submitted for the 2013 National Reports.........................................18
Casemix.........................................................................................................................................19
Admitted from..............................................................................................................................20
Pre-operative AMT score...............................................................................................................21
Post-operative AMT score..............................................................................................................22
A&E to orthopaedic ward in 4 hours (Blue Book Standard 1) .......................................................23
Type of anaesthesia.......................................................................................................................24
Time to surgery.............................................................................................................................25
Surgery within 36 hours of admission...........................................................................................26
Surgery on the day or day after admission....................................................................................27
Surgery within 48 hours and during normal working hours (Blue Book Standard 2).....................28
Reason for delay beyond 36 hours................................................................................................29
Cumulative time to surgery...........................................................................................................30
Patients treated without surgery...................................................................................................31
Operations performed by fracture type................................................................................... 3237
Development of pressure ulcers (Blue Book Standard 3) ..............................................................38
Pre-operative medical assessments (Blue Book Standard 4)..........................................................39
Bone health assessment and treatment at discharge (Blue Book Standard 5)...............................40
Specialist falls assessment (Blue Book Standard 6)........................................................................41
Length of acute and post-acute Trust stay (NHFD data)................................................................42
Superspell (third party data)..........................................................................................................43
Discharge destination from Trust..................................................................................................44
Re-operation within 30 days.........................................................................................................45
Follow up data completeness at 30 and 120 days................................................................... 4647
Casemix adjusted outcomes.................................................................................................... 4852
Trend analysis................................................................................................................................53
Best Practice Tariff................................................................................................................... 5460
Facilities Audit......................................................................................................................... 6164
Regional summary tables........................................................................................................ 6576
Glossary (terms denoted by )................................................................................................. 7778
References.....................................................................................................................................79
Appendix A Using audit to improve care Good practice examples .................................... 8085
Appendix B Facilities Audit tables......................................................................................... 8692
Further appendices........................................................................................................................93
Acknowledgements.......................................................................................................................94
Copyright National Hip Fracture Database 2013. All rights reserved.3
Executive summary
The National Hip Fracture Database (NHFD) is a clinically led, web-based audit of hip fracture care
and secondary prevention. All 186 eligible hospitals in England, Wales and Northern Ireland are now
regularly uploading data.
The NHFD is the largest and fastest-growing national hip fracture audit in the world with:
Over quarter of a million cases recorded since its launch in 2007
95% of all cases occurring annually being documented by the NHFD
5,500 records being added every month
This report covers casemix, care and outcomes of 61,508 cases submitted between 1 April 2012 and 31
March 2013 by 180 hospitals meeting the case threshold of 100 (or a high percentage submission rate
in smaller hospitals).
Care is audited against standards defined by the British Orthopaedic Association (BOA) and British
Geriatrics Society (BGS), and comparison with the same six standards from our 2012 National Report
shows that this year:
50% of patients are admitted to an orthopaedic ward within four hours (down from 52% in 2012)
86% receive surgery within 48 hours (improved from 83%)
3.5% are reported as having developed pressure ulcers (improved from 3.7%)
47% are reported as assessed pre-operatively by an orthogeriatrician (up from 43%)
69% are discharged on bone protection medication (unchanged)
94% received a falls assessment prior to discharge (up from 92%)
Our results are set alongside data from national data sources to allow a more comprehensive picture of
total length of stay and mortality.
Casemix adjusted reporting on two key measures (30 day mortality, and return to own home by
30days) is used to compare different hospitals outcomes.
These outcomes are drawn against the mean and standard deviation according to the size of the unit
and in the case of 30-day mortality, protocols have been developed to check the quality of data for
outlying hospitals, and to feed back information that might help them in reviewing their clinical service.
Five hospitals triggered an alert in terms of significantly increased 30 day mortality in this analysis, and
their performance was reviewed with reference to the data submitted over the three year period
201013.
For three hospitals this alert needs to be viewed alongside reassuring figures for previous years, but
two were confirmed to exhibit a consistent cause for concern.
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These two hospitals showed a consistent pattern, significant at a 95% level of confidence.
Clinicians and managers have used NHFD participation to prompt, monitor and evaluate clinical and
service developments to improve the quality and cost effectiveness of hip fracture care. The report
includes brief summaries of successful innovations that might encourage similar developments
elsewhere.
In England, the NHFD has successfully supported the first four years of the Department of Healths Best
Practice Tariff (BPT) initiative, which rewards the achievement of specified standards:
surgery within 36 hours
shared care by surgeon and geriatrician
care protocol agreed by geriatrician, surgeon and anaesthetist
assessment by geriatrician within 72 hours
pre- and post-operative abbreviated mental test score assessment
geriatrician-led multi-disciplinary rehabilitation
secondary prevention of falls
bone health assessment
Participation in BPT has steadily increased between 2010 and 2013.
A temporary fall at the start 201213 reflected the additional challenge of a requirement to perform
the abbreviated mental test, but in the last quarter 60% of patients have achieved BPT a marked
improvement on the 55% figure for the same period in 201112.
This National Report describes 61,508 admissions with hip fracture across England, Wales and Northern
Ireland. We show that this equates with the continuous occupation of over 4,000 beds across the NHS.
It is clear that the NHFD serves as a vital means of auditing the management of a condition which costs
one and a half billion pounds each year.
Introduction
This year marks the 50th anniversary of Bobby Irvine and Michael Devas description of the first
collaborative approach to the care of frail older people with hip fracture. The geriatric orthopaedic unit
they set up in Hastings was the first of many such services which were developed to meet the needs of
these patients.
Other enthusiasts subsequently put together informal or formal arrangements suited to the particular
pressures in different parts of the country with diverse patterns of referral, liaison and collaborative
care emerging over the years. Many different models evolved, so that it is only in the last few years that
an evidence base has emerged to prove the benefits associated with such collaborative working.
This fifth National Report of the NHFD gives us an opportunity to salute the legacy of Devas and Irvine.
The National Hip Fracture Database

In 2005 the success of collaboration between the BOA and the BGS in providing training for junior
surgeons and geriatricians led these organisations to champion a change in approach to the care
of older people with hip fracture in this country. Their joint publication of the Blue Book The care
of patients with fragility fracture1 proposed six quality standards which remain central to the
organisation of care for this vulnerable group of individuals.
Health organisations were challenged to provide prompt admission to orthopaedic wards, early
surgical repair of the fracture, protection against pressure ulcers, routine access to acute orthogeriatric
assessment and support, and assessment for bone protection therapy and falls prevention to avoid
future falls and fractures.
At the same time the BOA and the BGS proposed an independent, clinically-led, web-based audit to
monitor the quality and outcome of the care provided to individual patients, and to help individual
trauma units to improve the organisation of their services.
With start-up funding from industry sources the NHFD was launched in 2007. In 2009 the NHFD was
recognised by the National Clinical Audit Advisory Group for central funding, and the programme
secured Healthcare Quality Improvement Partnership (HQIP) funding until 2014.
From 2012 the NHFD moved to be managed as part of the Falls and Fragility Fracture Audit Programme
(FFFAP) within the Royal College of Physicians in London, benefitting from links with the other FFFAP
work-streams addressing the development of Fracture Liaison Services and the prevention of falls in
institutional care settings.
As organisations redesign their services, the number of hospitals treating acute hip fractures has
reduced slightly. All 186 eligible hospitals in England, Wales, Northern Ireland and the Channel Islands
are registered with NHFD, and all now regularly contribute data.
The NHFDs ability to detail casemix, performance and outcome, prompted the selection of hip fracture
as a topic for the Department of Healths BPT initiative2 in England. This offers additional payment when
the NHFD records that a patients care meets agreed standards surgery within 36 hours, jointly agreed
care protocols, shared care, cognitive assessment, geriatrician-led peri-operative assessment and multidisciplinary rehabilitation, and secondary prevention including falls and bone health assessment.
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Since the start of BPT in April 2010 we have seen a steady rise in the number of participating hospitals,
of cases submitted, and of cases meeting the tariff standards.
Individual trauma units upload casemix, clinical performance monitoring, and outcome details into
a simple web-based tool. These data are analysed throughout the year, so clinicians and healthcare
managers can use the same web-site to monitor their monthly and annual performance against the six
standards of the Blue Book and to benchmark their performance against other units on a regional or
national basis.
With a tendency towards increasing specialisation and centralisation of trauma services many patients
will be admitted to units that are some way from their home, and may move to rehabilitation wards
and community rehabilitation beds before their eventual discharge. The development of clinical
pathways across different hospitals, Trusts, and other organisations is crucial if such care is to be
efficiently organised and if patients are to be offered continuity of clinical care. The development of
orthogeriatric clinical networks has been an additional benefit of units collaboration in the NHFD.
The NHFD project coordinators have organised a series of well-attended regional meetings, to bring
together clinicians and managers to share expertise, and improve the quality and cost-effectiveness
of the care they provide. The NHFD web-site offers additional support; case studies, good practice
examples, model job descriptions, and business plans, so that by sharing information individual
clinicians can benefit from others experience.
The success of all this is demonstrated in this fifth National Report but the NHFD is far more than just
an annual report, and this document should be read as just part of the NHFDs work.
The 2013 National Report

Earlier this year the total number of patients recorded in the NHFD exceeded a quarter of a million.
This report considers a total of 61,508 patients admitted between 1 April 2012 and 31 March 2013
bringing together data from all 180 hospitals in England, Wales and Northern Ireland which reported
data on over 100 cases or (in the five units which admit fewer than this) reported data on over two
thirds of their cases.
The main body of the report presents comparative data in a series of tables and charts which rank
individual hospitals. These allow a local team to understand how their casemix patients age, sex-ratio,
place of residence, anaesthetic grade, cognitive state, walking ability, and fracture type compare with
that reported in other units.
In this years report we rank hospitals on the basis of the proportion of hip fractures which have been
sustained following an in-patient fall (Chart 2). The fact that inpatient fallers make up as much of
15% of admissions to some units will be of interest to local health providers, as will the observation
that the catchment area of some of these units includes hospitals with no alternative to single room
accommodation.
The same approach is used to describe the patients progress from admission through to discharge,
with details of time to an orthopaedic ward and time to surgery, and of operations performed, medical
assessment, development of any pressure ulcers, secondary prevention measures, length of acute
hospital stay and destination on discharge.
Outcome is summarised with a number of key measures which have been adjusted to take into account
the casemix of the patients admitted to individual hospitals.
The priority of most patients and their families is that they are helped to regain independence and
mobility, and are able to return to their previous residence as soon as possible. Casemix adjusted data
on the percentage of patients returning to their own home by 30 days after hip fracture are therefore
our key outcome measure. The report also includes casemix adjusted mortality figures at 30 days.
For the first time, this report includes overall NHS length of stay or super-spell figures, not only for
England, but also for Wales and Northern Ireland. These have been derived from reference to national
databases Health Episode Statistics (HES) in England, Patient Episode Database Wales (PEDW) in Wales,
and Fracture Outcome Research Database (FORD) in Northern Ireland. This super-spell data at last
addresses the difficulty of describing the overall patient experience when different stages of care are
provided in different organisations. Figures from different hospitals, Trusts, and other NHS organisations
are being linked to define how long it actually takes a patient to return home, or to be settled in their
placement.
Progress so far
Performance
This report includes much of which we should be proud when we measure it against the six Blue
Book standards which stimulated the NHFDs original development. We can see a progressive pattern
of improvement across the four standards for which the NHFD has been the principal driver
orthogeriatric assessment, the prevention of pressure sores, and prevention of future falls and fractures.
Standard
2009
2010
2011
2012
2013
1. Admission to orthopaedic ward within 4 hours
N/A
55%
56%
52%
50%
2. Surgery within 48 hours and during working hours
75%
80%
87%
83%
86%
3. Patients developing pressure ulcers
N/A
6%
3.7%
3.7%
3.5%
4. Pre-operative assessment by an orthogeriatrician
24%
31%
37%
43%
49%
5. Discharged on bone protection medication
N/A
57%
66%
69%
69%
6. Received a falls assessment prior to discharge
44%
63%
81%
92%
94%
In order to ensure comparability with previous reports, the percentages quoted above are based on the exclusion of unknown data.
Of concern, only half of patients are now admitted to an orthopaedic ward within four hours of
presentation this figure having again fallen compared to the 56% we reported in 2011. This coincides
with a reduced emphasis on this as a target, but may reflect the tendency for hip fracture patients to be
placed in the generic admission wards which have evolved as a means of responding to the increasing
numbers presenting to Emergency Units.
On a more positive note, the proportion of patients being offered surgery within 48 hours has
stabilised, with a slight improvement after the deterioration we reported last year. The significant
variation in performance around the country that we report suggests that there is still considerable
room for further improvement.
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The more ambitious target set by National Institute for Health and Care Excellence (NICE)3 in 2011
remains a challenge with only 70% of patients currently being offered surgery on the day of, or the
day after admission.
Mortality
Hip fracture is the commonest cause of injury related death, and is commonly seen by patients, their
relatives and friends as the final insult that led to their death. Many of these deaths are a reflection of
frailty and pre-existing illness, and not all mortality is preventable. Variation in the age and complexity of
patients admitted to different hospitals makes it challenging to demonstrate whether an individual unit
is doing everything necessary to avoid preventable deaths, but casemix adjustment helps us to correct
for this.
The overall rate of mortality at 30 days in the casemix adjusted analysis is 8.2% compared with
the 8.1% figure we reported for 201112 in our supplement earlier this year. Some of the apparent
variation in mortality between units will be a chance statistical finding, but our approach does allow
us to identify units where performance is particularly poor, and to highlight those where outstanding
performance should be recognised.
We identified a number of Trusts (FRY, LDH, STR, WAT, WHH) which are outliers in that they fall outside
the 2SD threshold in this years funnel plot [Chart 29].
However, it is not clear that this indicates a consistent pattern of failing or justifiable cause for
concern. FRY and WHH were not outliers when data collected over the three year period 201013
was considered, and although STR did remain an outlier in this three year analysis, the absolute excess
mortality for each of these units was less than one case per year.
In contrast, two units (LDH and WAT) triggered concerns on 201213 data, and were still outliers when
the three years data were analysed. Both units remained at or above the 3SD alarm threshold for the
201013 period [Chart 30]. Each showed an excess mortality which in absolute terms equated with over
12 deaths during the three year period, and which was significant at a 95% confidence limit.
Return home
Older people often report being more concerned about potential loss of independence, than about the
risk of dying after a hip fracture. As a result success in rehabilitation remains the NHFDs key marker of
the quality of multidisciplinary care.
The overall rate of return home from home at 30 days for all cases included in the case-mix adjusted
analysis was 43.3% in 2011, 44.6% in 2012, and this year has improved further to 46.2%.
The quality of follow-up data has again improved this year, but these figures continue to be based on
relatively poor data returns, with only 44.8% complete for the 30 day time point.
Length of Stay
Length of stay (LOS) is the main component of the overall cost of hip fracture care. Potential reductions
in LOS were key to the improved cost-effectiveness achieved by Hip Fracture Programmes that were
identified by the economic model of the NICE Guideline3 (CG124) on hip fracture.
This report describes a further small reduction in the mean length of acute and post-acute stay within
the admitting hospital from 21.2 days in 2011, to 20.2 days in 2012 and 20 days this year (Chart
22).
The NHFD has commissioned the Royal College of Surgeons Clinical Effectiveness Unit (RCS CEU) to link
data on individual patients in the NHFD with details of their inpatient care held in national databases.
This seeks to capture length of stay not only in the hospital to which a patient is originally admitted, but
also the whole of subsequent NHS stay in other Trusts or organisations.
The first description of this approach to super-spell was included in our supplementary report
published earlier this year. That report considered patients in England using Health Episode Statistics
(HES) data for the 201011 year.
In this 2013 National Report we include the same analyses for the 201112 year extended with new
data from PEDW data from Wales, and with additional data from FORD for Northern Ireland (Chart 23).
The development of Local Health Boards means that in Wales patients do not move between acute and
community Trusts in the same geographical area. There is less need to identify the elements of care
provided by different organisations, and PEDW categorises length of stay differently from HES. PEDW
data simply split between a spell of trauma/rehabilitation in the admitting hospital, and any spell of
rehabilitation or long-stay inpatient care that might follow in a second hospital.
Technical and practical difficulties inherent in attempting to identify 60,000 patients with hip fracture
in HES mean that while this report features NHFD figures for 201213, we report super-spell figures for
201112.
In spite of this the super-spell data gives a crucial insight into the real cost of hip fracture capturing
the whole time a patient has to spend in hospital, and the whole cost to the health service in terms of
overall hospital bed occupancy.
The HES figure for mean super-spell in England is 22 days. This may still understate NHS stay as
it remains unclear whether HES reliably captures the full extent of NHS funded rehabilitation in
intermediate care and care homes which is an increasingly important component of Community Trust
provision in England.
In contrast PEDW records a super-spell of 35 days in Wales, reflecting a LOS in rehabilitation beds that is
over twice as long as the figure for England. This pattern is consistent with data submitted to the NHFD;
nine of the ten longest LOS figures being for hospitals in Wales. Long-stay and continuing care hospital
beds are an element of provision in Wales, but the impact of long-stay patients will have been limited in
this report since LOS figures beyond 365 days are excluded from this analysis.
The FORD data indicate a super-spell of 33 days for Northern Ireland that is also substantially longer
then the HES figure for England. This will in part reflect a greater use of rehabilitation beds as part of
a hub and spoke model, with centralisation of hip fracture surgery in a small number of trauma units
which serve a wide geographic catchment area.
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Future development of the NHFD

Improving ascertainment
This national report contains the most complete data set so far the largest number of hospitals, the
largest number of patients, and the most complete datasets.
A national clinical audit should seek to acquire complete data on all cases, and the NHFD constantly
questions what might be happening in situations where patients are not being reported:
hospitals which in the past were not submitting any data
hospitals which still submit too few patients to support reliable analysis
hospitals where a proportion of patients are missed, but where there is a risk that these may be
missed for a reason that might lead to biased performance and outcome figures (for instance if fitter
patients were lost when moved for total hip replacement in a different unit)
hospitals where follow-up is incomplete and where there is a risk of bias (for instance, if inpatient
deaths are all recorded, but some discharge data missed estimates of inpatient mortality might be
artificially elevated)
Encouragingly, since May 2013 all hospitals are now contributing data. Only 6 units were excluded from
this years report on the basis of the poor number of cases submitted. Individual charts in the report
highlight where data is incomplete. However, it is not straightforward to establish how complete our
data are, since there is no external gold-standard against which our figures could be checked.
Until this year the most reliable available estimate of total hip fracture numbers for these countries has
been our own from participating sites Facilities Audit reports of how many patients they are seeing.
Increasingly these units estimates have been based on previous years experience of data submission to
the NHFD, refined by local understanding of whether a proportion of patients might have been missed.
However, we have attempted to validate the completeness of case ascertainment through the RCS CEU
data comparison exercise described above.
The HES and PEDW databases have their own uncertainties, and in particular their dependence on
coding means that they may not identify all patients with hip fracture. HES showed 59,344 admissions
in England in 201112, PEDW showed 3,804 admissions in Wales.
These figures correspond well with our own estimates. Our facilities audit had estimated 58,638 hip
fracture admissions in England, and 3,810 in Wales, and for 201213 we report data submitted on
55,998 in England, and on 3,665 in Wales.
FORD identified 1,695 patients in Northern Ireland in 201112. The NHFD already links directly
with FORD so numbers will correspond very closely. All four hospitals in Northern Ireland are now
contributing data, so for 201213 our facilities audit estimate increased to 1,936, and this report
includes 1,845 patients.
There is no reason to believe that HES and PEDW provide a more reliable estimate of total hip fracture
numbers than our own figures, but we can feel confident in our case ascertainment since we have
collected and report data on 94.9% of all the hip fractures recorded in these national databases, and on
95.5% of the number expected from our own facilities audit.
Improving follow-up
Follow-up data remains disappointing in some areas, and 30 day follow-up data is only complete in
37.4% of cases. However, this report still demonstrates an immediate impact on patient independence,
with new care home placements for a significant number of those who suffer a hip fracture.
We show that 23% of those surviving the injury go to care homes directly from the acute hospital (only
19.2% were admitted from such care), and a further 21.6% transfer to rehabilitation wards. At present
the incompleteness of follow-up data for the patients who are offered additional rehabilitation means
that the overall rate of new care home placement following hip fracture cannot be estimated.
Given that each such placement after hip fracture carries a mean life-time cost of 64,000 an
understanding of longer term outcome would be a key economic measure that the NHFD should seek
to deliver. Such a move may reflect greater difficulty with mobility or self-care, but may also reflect a loss
of confidence on the part of the patient or their relatives so that a fear of future falls precipitates a
move to institutional care.
Provision of coordinated multidisciplinary rehabilitation and secondary prevention of falls are clearly key
to avoiding unnecessary loss of independence.
Improving description of care

This and previous National Reports have been focused on audit of current practice against the standards
set out in the BOA/BGS Blue Book and the criteria set out for BPT in England.
The demonstration that 78.4% of patients are having a post-operative abbreviated mental test is an
indication of how rapidly participating hospitals can respond to innovation or change in these criteria.
Ongoing work seeks to extend this remit so that we can explore other aspects of care, and other
measures of performance and outcome. Short term Sprint audits will be the first step in this
development.
The NHFD and Anaesthetic Management

Anaesthesia was not included in the initial core dataset for the NHFD as these details did not form part
of the Blue Book standards. However, since April 2011 limited information has been collected on the
type of anaesthesia, and the use of nerve blocks for hip fracture surgery as part of the core dataset.
In 2011 representatives from NHFD and the Association of Anaesthetists of Great Britain and Ireland
(AAGBI) decided to collaborate and develop a comprehensive Anaesthesia Sprint Audit of Practice
(ASAP).
This seeks to assess adherence to the AAGBI guidelines4 on the management of proximal femoral
fracture which in 2011 recommended:
that surgery and anaesthesia are undertaken by appropriately experienced surgeons and
anaesthetists
that the Nottingham Hip Fracture Score5 is used to predict Postoperative mortality
consideration of spinal/epidural anaesthesia for all patients undergoing hip fracture repair unless
otherwise contraindicated
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not using opioid analgesics as the sole adjunct to anaesthesia
that either spinal or general anaesthesia is administrated (simultaneous administration is associated
with precipitous falls in blood pressure)
use of supplemental oxygen during spinal anaesthesia
co-administration of intrathecal opioids during spinal anaesthesia
pre or Postoperative peripheral nerve blockade to supplement either general or spinal anaesthesia
monitoring of intraoperative blood pressure
identification of bone cement implantation syndrome, by monitoring for hypoxia or hypotension
shortly after cementing or reaming
The objectives of the ASAP sprint audit are to:
describe the use of different anaesthesia, peripheral nerve blockade, opioids and sedative medication
define the prevalence and implications of hypotension developing during anaesthesia
establish the seniority of the operating surgeon/anaesthetist
identify operative markers of bone cement implantation syndrome
establish whether the Nottingham Hip Fracture Score is a robust method of conducting casemix
analysis
Data is being collected prospectively in the summer of 2013. The ASAP sprint will involve the addition of
8 fields to the NHFD data set. ASAP data will be linked to outcome measures of the NHFD; primarily 30day mortality, Postoperative worsening of abbreviated mental test score, and return to normal residence.
Currently, out of the 186 hospitals contributing to the NHFD 167 hospitals have signed up for the ASAP
sprint audit.
The NHFD and NICE Quality Standard 16

In 2011 NICE published The Management of Hip Fracture in Adults3 along with a series of
implementation tools and resources. In 2012 they published a set of Quality Standards for hip fracture
(NICE QS16)6.
These included a number of areas about which the existing NHFD dataset provides information, and this
report already includes charts which test specific standards within QS16 in particular those which state
that people with hip fracture should:
have their cognitive status assessed, measured and recorded from admission
have surgery on the day of, or the day after, admission
receive cemented arthroplasty for displaced intracapsular fracture, with the offer of total hip
replacement if clinically eligible
be offered a multifactorial risk assessment to identify and address future falls risk, and are offered
individualised intervention if appropriate
be offered a bone health assessment to identify future fracture risk and pharmacological intervention
as needed before discharge from hospital.
The NHFD team is currently proposing a new Sprint Audit to extend the NHFDs coverage to the
remaining elements of QS16 quality standards which state that people with hip fracture should:
receive prompt and effective pain management, in a manner that takes into account the hierarchy of
pain management drugs, throughout their hospital stay
have their surgery scheduled on a planned trauma list, with consultant or senior staff supervision
receive extramedullary implants such as a sliding hip screw in preference to an intramedullary nail for
trochanteric fractures above and including the lesser trochanter (AO classification types A1 and A2)
be offered a physiotherapist assessment the day after surgery and mobilisation at least once a day
unless contraindicated
be offered a formal Hip Fracture Programme from admission
be offered early supported discharge (if they are eligible), led by the Hip Fracture Programme team
and that the Hip Fracture Programme team retains a comprehensive and continuing clinical and
service governance lead for all stages of the pathway of care, including the policies and criteria for
both intermediate care and early supported discharge
It is planned that these areas should form the focus of a specific Sprint Audit an audit that would
also approach the question of the patient experience. Since cognitive impairment is so prevalent in this
patient group this will be challenging, but an extension of our work to assess the quality of the patients
experience with respect to pain management is clearly a minimum requirement if we are to understand
the impact of hip fracture from their perspective.
Further detail on how NHFD reporting maps to NICE Clinical Guidance can be found in our 2012
National Report (available on nhfd.co.uk) Charts which report against NICE guidance are indicated with
the tag
NICE CG 124
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The NHFD and Clinical Commissioning Groups

The Clinical Commissioning Group Outcomes Indicator Set is currently being developed as part of NHS
Englands approach to quality improvement. Its aim is to support Clinical Commisioning Groups (CCGs)
and health and wellbeing partners, to plan for health improvement and to provide clear, comparative
information for patients and the public about the quality of health services commissioned by CCGs.
The following hip fracture indicators are included in the set of recommended indicators that are under
consideration by NHS England for 20141515.
If accepted, hip fracture incidence will be calculated from the Hospital Episode Statistics. The remaining
three indicators will be derived from data submitted to the NHFD:
1. Of people with hip fracture, the proportion who receive a formal Hip Fracture Programme from
admission evidenced as having a joint acute care protocol at admission, and evidence of MDT
rehabilitation agreed with a [named responsible orthogeriatrician and orthopaedic surgeon, with
GMC numbers recorded.
2. Of people with hip fracture, the proportion who receive surgery on the day of, or the day after,
admission.
3. Of people with hip fracture, the proportion who receive a multifactorial risk assessment of future
falls risk, led by the Hip Fracture programme team evidenced by GMC number of responsible
clinician.
This reinforces the importance of submitting complete, accurate data to the NHFD.
Participating hospitals
Indicates inclusion in this report n=180; indicates hospitals participating in NHFD but not submitting
sufficient data to be included in this report n=6
In the following charts, hospitals are identified using their unique three letter code
Addenbrookes Hospital, Cambridge
Airedale General Hospital
Alexandra Hospital
Altnagelvin Area Hospital
Arrowe Park Hospital, Wirral
Barnet Hospital
Barnsley Hospital
Basildon and Thurrock University Hospital
Basingstoke and North Hampshire Hospital
Bassetlaw District General Hospital
Bedford Hospital
Birmingham Heartlands
Bradford Royal Infirmary
Bristol Royal Infirmary
Bronglais General Hospital, Aberystwyth
Broomfield Hospital
Charing Cross Hospital
Chase Farm Hospital
Chelsea and Westminster Hospital
Cheltenham General Hospital
Chesterfield Royal Hospital
Colchester General Hospital
Conquest Hospital, Hastings
Countess of Chester Hospital
County Hospital, Hereford
Craigavon Area Hospital
Croydon University Hospital
Cumberland Infirmary, Carlisle
Darent Valley Hospital, Dartford
Darlington Memorial Hospital
Derbyshire Royal Infirmary
Derriford Hospital, Plymouth
Diana Princess of Wales Hospital, Grimsby
Doncaster Royal Infirmary
Dorset County Hospital
Ealing Hospital
East and North Herts Hospital
East Surrey Hospital, Redhill
Eastbourne Hospital
Frenchay Hospital, Bristol
Frimley Park Hospital, Camberley
Furness General Hospital, Barrow-in-Furness
16
ADD
AIR
RED
ALT
WIR
BNT
BAR
BAS
NHH
BSL
BED
EBH
BRD
BRI
BRG
BFH
CHS
WES
CHG
CHE
COL
CGH
COC
HCH
CRG
MAY
CMI
DVH
DAR
DER
PLY
GGH
DID
WDH
ENH
ESU
DGE
FRY
FRM
FGH
George Eliot Hospital, Nuneaton

Glan Clwyd Hospital, Rhyl
Gloucester Royal Hospital
Good Hope Hospital
Grantham and District Hospital
Guys and St. Thomas Hospital
Gwynedd Ysbyty, Bangor
Harrogate District Hospital
Hillingdon Hospital
Hinchingbrooke Hospital
Homerton University Hospital
Horton Hospital, Banbury
Huddersfield Royal Infirmary
Hull Royal Infirmary
James Cook University Hospital
James Paget University Hospital
Jersey General Hospital
John Radcliffe, Hospital, Oxford
Kettering General Hospital
Kings College Hospital, London
Kings Mill Hospital, Sutton in Ashfield
Kingston Hospital
Leeds General Infirmary
Leicester Royal Infirmary
Leighton Hospital, Crewe
Lincoln County Hospital
Luton and Dunstable Hospital
Macclesfield General Hospital
Manchester Royal Infirmary
Manor Hospital, Walsall
Medway Maritime Hospital
Milton Keynes General Hospital
Morriston Hospital, Swansea
Musgrove Park Hospital, Taunton
Nevill Hall Hospital
New Cross Hospital, Wolverhampton
Newham General Hospital
Nobles Hospital, Isle of Man
Norfolk and Norwich University Hospital
North Devon District Hospital
North Manchester General Hospital
North Middlesex University Hospital
NUN
CLW
GLO
GHS
STH
GWY
HAR
HIL
HIN
HOM
HOR
HUD
HRI
SCM
JPH
RAD
KGH
KCH
KMH
KTH
LGI
LER
LGH
LIN
LDH
MAC
MRI
WMH
MDW
MKH
MOR
MPH
NEV
NCR
NWG
NOB
NOR
NDD
NMG
NMH

North Tyneside General Hospital
Northampton General Hospital
Northern General Hospital, Sheffield
Northwick Park Hospital
Peterborough District Hospital
Pilgrim Hospital, Boston
Pinderfields General Hospital, Wakefield
Poole General Hospital
Prince Charles Hospital, Merthyr
Princess Elizabeth Hospital, Guernsey
Princess Of Wales Hospital
Princess Royal Hospital, Bromley
Princess Royal Hospital, Telford
QEQM, Margate
Queen Alexandra Hospital, Portsmouth
Queen Elizabeth Hospital, Birmingham
Queen Elizabeth Hospital, Kings Lynn
Queen Elizabeth Hospital, Gateshead
Queen Elizabeth Hospital, Woolwich
Queens Hospital, Burton upon Trent
Queens Hospital, Romford
Rotherham District General Hospital
Royal Albert Edward Infirmary, Wigan
Royal Berkshire Hospital, Reading
Royal Blackburn Hospital
Royal Bolton Hospital
Royal Devon and Exeter Hospital
Royal Free Hospital
Royal Glamorgan Hospital, Llantrisant
Royal Gwent Hospital
Royal Hampshire County Hospital
Royal Lancaster Infirmary
Royal Liverpool University Hospital
Royal Oldham Hospital
Royal Preston Hospital
Royal Shrewsbury Hospital
Royal Surrey County Hospital, Guildford
Royal Sussex County Hospital, Brighton
Royal United Hospital, Bath
Royal Victoria Hospital, Belfast
Royal Victoria Infirmary, Newcastle
Russells Hall Hospital, Dudley
Salford Royal Hospital
Salisbury District Hospital
Sandwell General Hospital
Scarborough General Hospital
Scunthorpe General Hospital
South Tyneside District Hospital
Southampton General Hospital
Southend University Hospital
Southport District General Hospital
St Georges Hospital
NTY
NTH
NGS
NPH
PET
PIL
PIN
PGH
PCH
POW
BRO
TLF
QEQ
QAP
QEB
QKL
QEG
GWH
BRT
OLD
ROT
AEI
RBE
BLA
BOL
RDE
RFH
RGH
GWE
RHC
RLI
RLU
OHM
RPH
RSS
RSU
RSC
BAT
RVB
RVN
RUS
SLF
SAL
SAN
SCA
SCU
STD
SGH
SEH
SOU
GEO
St Helier Hospital, Carshalton

SHC
St. Marys Hospital, Isle of Wight
IOW
St. Marys Hospital, Paddington
STM
St Peters Hospital, Chertsey
SPH
St Richards Hospital, Chichester
STR
Stafford Hospital
SDG
Stepping Hill Hospital, Stockport
SHH
Stoke Mandeville, Aylesbury
SMV
Sunderland Royal Hospital
SUN
Tameside General Hospital, Manchester
TGA
The Great Western Hospital, Swindon
PMS
The Ipswich Hospital
IPS
The Princess Alexandra Hospital, Harlow
PAH
The Royal Cornwall Hospital,
RCH
The Royal London Hospital
LON
Torbay District General Hospital
TOR
Trafford General Hospital
TRA
Tunbridge Wells Hospital
TUN
Ulster Hospital, Dundonald
NUH
Queens Medical Centre, Nottingham
UHN
University College Hospital , London
University Hospital of North Staffs,
Stoke-on Trent
STO
University Hospital Aintree
FAZ
University Hospital Coventry (Walsgrave site) UHC
University Hospital Of North Durham
DRY
University Hospital of North Tees
NTG
University Hospital of Wales, Cardiff
UHW
University Hospital, Lewisham
LEW
Victoria Hospital, Blackpool
VIC
Wansbeck Hospital
ASH
Warrington Hospital
WDG
Warwick Hospital
WAR
Watford General Hospital
WAT
West Cumberland Hospital, Whitehaven
WCI
West Middlesex University Hospital
WMU
West Suffolk Hospital, Bury St Edmonds
WSH
West Wales General Hospital , Carmarthen WWG
Weston General Hospital,
Weston-Super-Mare WGH
Wexham Park Hospital, Slough
WEX
Whipps Cross University Hospital
WHC
Whiston Hospital, Prescot
WHI
Whittington Hospital
WHT
William Harvey Hospital, Ashford
WHH
Withybush Hospital, Haverford West
WYB
Worcestershire Royal Hospital
WRC
Worthing and Southlands Hospital
WRG
Maelor Hospital, Wrexham
WRX
Wythenshawe Hospital, Manchester
WYT
Yeovil District Hospital
YEO
York Hospital
YDH
Chart 1 Completeness of data fields on cases included in the

2013 National Report
Data:
0%
Total number of fields

1,390,457
Total number of fields
completed 1,305,286
(93.9%)
All 180 hospitals included
in chart
20%
40%
60%
80%
RDE
QAP
RUS
NUN
PAH
BAS
BRI
NOR
RHC
GLO
PIN
CGH
STM
ASH
YDH
UHC
BLA
QEG
PIL
SPH
FRM
NTY
ROT
MDW
WSH
AEI
CMI
RVN
BOL
WRG
WIR
VIC
PMS
JPH
PGH
MRI
WAR
WHH
MKH
SDG
KMH
GHS
SUN
CHG
STH
FRY
EBH
RBE
SCU
DVH
COC
NCR
ENH
OLD
BRD
RLU
TOR
RCH
NHH
BSL
WHT
LON
HRI
WAT
TGA
RSC
LEW
IOW
ADD
STR
DGE
SHC
PET
HAR
KTH
CHS
OHM
PLY
WYT
SHH
NMH
AIR
WDG
Incomplete (6.1%)
SAL
HUD
Hospital
Complete (93.9%)
QEQ
TRA
SLF
HOR
RED
IPS
RFH
WMH
RSU
UHN
DID
WES
BAR
NUH
WHC
LIN
MAY
SOU
LDH
WHI
STO
BNT
FAZ
BED
SEH
BAT
NTG
SMV
SAN
NMG
WMU
SCA
SCM
GGH
NGS
MAC
NWG
HCH
COL
BRT
FGH
NTH
CRG
GWE
MPH
DRY
DAR
DER
GWH
LGH
LER
NDD
BRO
QKL
WRX
WRC
YEO
NOB
STD
MOR
HIL
TUN
ESU
GEO
RLI
WEX
CHE
QEB
ALT
WDH
NEV
WGH
RVB
LGI
HIN
HOM
RSS
CLW
WCI
BFH
SGH
NPH
TLF
UHW
POW
PCH
WWG
WYB
RAD
BRG
KGH
GWY
RGH
KCH
RPH
ALL
0%
18
100%
20%
40%
60%
80%
100%

Casemix
The outcome following a hip fracture depends on the overall health of the individual patient. Although
age may be an indicator of frailty, it is not necessarily true that older patients will recover less well than
younger patients. Guidelines on the care of hip fracture are not age based and an overall assessment
of the patients health is an important part of planned treatment. As there are regional variations in
population health, the NHFD case-mixes the outcome of treatment, so as to allow for fair comparison.
In previous reports Age at admission, Gender, American Society of Anesthesiologists (ASA) grading,
Walking ability and Fracture type were all reported as separate charts. However, these show little change
year on year and only the residency status place of admission and Abbreviated Mental Test (AMT)
Scores have been included in this report.
Gender
Age
ASA
completed
ASA grade
Walking
ability
Fracture
type
200910
201011
201112
201213
Male
26.0%
26.1%
26.0%
26.8%
Female
74.0%
73.9%
74.0%
73.2%
6069
8.0%
8.4%
8.3%
8.7%
7079
23.0%
22.6%
22.2%
21.7%
8089
50.0%
48.0%
48.2%
47.4%
90+
19.0%
21.0%
23.3%
22.1%
ASA known
Not reported
87.3%
90.2%
92.7%
ASA unknown
Not reported
12.7%
9.8%
7.3%
ASA 1
3.0%
2.6%
2.4%
2.2%
ASA 2
31.0%
31.9%
30.7%
29.7%
ASA 3
54.0%
54.4%
55.1%
55.5%
ASA 4
12.0%
10.8%
11.4%
12.2%
ASA 5
< 1.0%
0.4%
0.4%
0.4%
Without aids
46.0%
45.2%
45.8%
46.1%
1 aid
24.0%
24.9%
24.9%
24.2%
2 aids/frame
23.0%
23.5%
23.7%
24.6%
Wheelchair
2.0%
2.5%
2.4%
2.4%
Unknown
5.0%
3.8%
3.2%
2.7%
Intracapsular undisplaced
12.0%
11.4%
10.9%
10.1%
Intracapsular displaced
45.0%
46.3%
46.8%
47.5%
Intertrochanteric
35.0%
33.8%
34.3%
35.0%
Sub-trochanteric
5.0%
5.0%
5.4%
5.7%
Other
3.0%
2.9%
1.8%
1.2%
< 1.0%
0.6%
0.8%
0.5%
Unknown
Chart 2 Admitted from

0%
Last year this chart was

ranked by the percentage
of patients admitted from
their own home.
20%
40%
60%
80%
ALT (350)
RVB (896)
UHN (739)
NUH (381)
QAP (732)
CMI (283)
WCI (131)
WGH (224)
CRG (218)
ROT (275)
VIC (414)
PAH (372)
HOR (148)
FGH (140)
In this report we have

ranked the chart by
percentage of patients
admitted from NHS
locations (Rehabilitation
Unit, Acute Hospital and
Already in Hospital).
RSU (330)
RSS (325)
NPH (245)
DVH (336)
WWG (332)
DER (489)
TLF (141)
BRG (92)
NOR (735)
AIR (275)
BSL (168)
PMS (376)
NWG (83)
HIN (152)
QEQ (372)
NDD (260)
COL (520)
YDH (368)
TOR (436)
WYB (144)
WHT (144)
QKL (323)
GGH (248)
NMH (138)
WRC (412)
MDW (339)
GHS (365)
TUN (351)
CGH (286)
YEO (190)
LGH (285)
DGE (373)
Already in hospital (4.1%)
EBH (482)
WAT (455)
WRG (503)
ENH (443)
MAY (274)
0%
SHH (332)
Hospital (N)
LIN (293)
Hospital (N)
20%
40%
60%
80%
RED (250)
KCH (114)
WHH (423)
RVB (896)
PCH (131)
NUH (381)
SCA (294)
CMI (283)
TRA (104)
WGH (224)
PIL (311)
ROT (275)
SCM (454)
PAH (372)
HCH (285)
FGH (140)
BFH (378)
RSS (325)
HIL (198)
DVH (336)
DID (371)
DER (489)
FRM (365)
BRG (92)
CHG (299)
AIR (275)
HRI (538)
PMS (376)
BAS (405)
HIN (152)
STR (349)
NDD (260)
RHC (273)
YDH (368)
MKH (109)
WYB (144)
RCH (639)
QKL (323)
MAC (246)
NMH (138)
SHC (379)
MDW (339)
NOB (85)
TUN (351)
KGH (356)
YEO (190)
MPH (368)
DGE (373)
STO (595)
BAT (489)
BOL (390)
WES (147)
WSH (284)
WDG (284)
NTG (376)
HOM (84)
WAR (295)
IOW (250)
JPH (340)
RSC (429)
COC (336)
WAT (455)
OHM (335)
ENH (443)
NHH (242)
MAY (274)
STH (191)
LIN (293)
SCU (242)
SHH (332)
QEB (414)
RED (250)
HUD (445)
WHH (423)
NMG (331)
PCH (131)
TGA (224)
SCA (294)
UHW (510)
TRA (104)
WHI (387)
PIL (311)
RLI (231)
SCM (454)
BRD (350)
HCH (285)
WHC (301)
BFH (378)
FRY (433)
HIL (198)
SUN (385)
DID (371)
CHS (190)
FRM (365)
BRI (345)
CHG (299)
NGS (588)
HRI (538)
BAR (250)
BAS (405)
RVN (401)
STR (349)
NTY (308)
RHC (273)
DRY (356)
MKH (109)
NEV (254)
RCH (639)
MAC (246)
ALL
STO (595)
BOL (390)
WSH (284)
NTG (376)
WAR (295)
JPH (340)
COC (336)
OHM (335)
NHH (242)
STH (191)
SCU (242)
QEB (414)
HUD (445)
NMG (331)
TGA (224)
CHE (347)
GEO (164)
RDE (522)
PGH (859)
ALT (350)
GLO (418)
UHN (739)
POW (240)
QAP (732)
NUN (252)
WCI (131)
IPS (436)
CRG (218)
DAR (351)
VIC (414)
HAR (286)
HOR (148)
RGH (243)
RSU (330)
QEG (318)
NPH (245)
AEI (316)
WWG (332)
GWH (269)
TLF (141)
RBE (449)
NOR (735)
OLD (558)
BSL (168)
SAL (278)
NWG (83)
SPH (441)
QEQ (372)
BRO (346)
COL (520)
NTH (364)
TOR (436)
SEH (392)
WHT (144)
SDG (230)
GGH (248)
BRT (293)
WRC (412)
KMH (344)
GHS (365)
ESU (509)
CGH (286)
WEX (338)
LGH (285)
ASH (333)
SAN (337)
RPH (390)
SOU (270)
RLU (395)
KTH (288)
MRI (173)
NCR (367)
LEW (202)
SMV (391)
RAD (526)
LDH (305)
WIR (462)
EBH (482)
BNT (305)
WRG (503)
FAZ (380)
ADD (450)
WRX (266)
CHE (347)
GWY (228)
WMU (216)
PLY (570)
GEO (164)
BED (176)
PGH (859)
PET (399)
GLO (418)
SGH (569)
POW (240)
STM (301)
NUN (252)
CLW (339)
IPS (436)
RFH (167)
DAR (351)
PIN (530)
HAR (286)
WMH (311)
RGH (243)
STD (208)
QEG (318)
MOR (534)
AEI (316)
BLA (463)
GWH (269)
RUS (485)
RBE (449)
WYT (291)
OLD (558)
LGI (639)
SAL (278)
UHC (486)
SPH (441)
SLF (223)
BRO (346)
LON (140)
NTH (364)
GWE (352)
SEH (392)
LER (768)
SDG (230)
KMH (344)
NOB (85)
KGH (356)
ADD (450)
100%WMU (216)
BRT (293)
SHC (379)
MPH (368)
20
LDH (305)
RSC (429)
Other (0.9%)
Acute hospital (0.4%)
SMV (391)
IOW (250)
Unknown (0.1%)
Rehabilitation unit (0.8%)
NCR (367)
HOM (84)
Already in hospital (4.1%)

This data
may help
local health providers
to understand the risk
of inpatient falls in their
locality.
Nursing care (7.4%)
KTH (288)
WDG (284)
Two ofResidential
the highest
rates of
care (11.8%)
admission from inpatient
Nursing care (7.4%)
care are in new hospitals
unit (0.8%)
whichRehabilitation
only provide
single
room Acute
accommodation.
hospital (0.4%)
Residential care (11.8%)
SOU (270)
WES (147)
housing (74.5%)
Own home/sheltered
housing (74.5%)
SAN (337)
BAT (489)
There is some variation in

the way in which these
fields are used locally, but
this gives an idea of the
proportion of patients
Unknown (0.1%)
who fracture
their hips in
hospital,
from 0%
Otherranging
(0.9%)
to 15%.
Own home/sheltered
100%
RDE (522)
KCH (114)
ESU (509)
0%
20%
40%
60%
80%
WEX (338)
ASH (333)
100%
RPH (390)
RLU (395)
MRI (173)
LEW (202)
One hospital
excludeddue
due to
data.
One hospital
excluded
toincorrect
incorrect
RADdata.
(526)
WIR (462)
BNT (305)
FAZ (380)
WRX (266)
GWY (228)
Copyright National Hip Fracture Database 2013. All rights PLY

reserved.
(570)
BED (176)
PET (399)
SGH (569)

Chart 3a Pre-operative AMT Score

0%
NICE CG 124
20%
40%
60%
80%
ASH (333)
BSL (168)
TGA (224)
NMH (138)
WMH (311)
The AMT Score is a simple

measure of cognitive
function. Pre and postoperative scores form part
of the assessment for Best
Practice Tariff.
AEI (316)
SDG (230)
SUN (385)
SCA (294)
DID (371)
IOW (250)
OHM (335)
NTG (376)
PIN (530)
ADD (450)
STM (301)
FGH (140)
NTY (308)
BED (176)
DAR (351)
BLA (463)
PET (399)
KMH (344)
WDH (256)
CHS (190)
SPH (441)
COC (336)
YDH (368)
SMV (391)
PAH (372)
BNT (305)
UHC (486)
RHC (273)
Only 87.8% (range 0% to

100%) of patients have a
preoperative score reflecting
the absence of BPT in Wales
and Northern Ireland.
SHC (379)
NGS (588)
NUN (252)
AIR (275)
NCR (367)
STO (595)
QEQ (372)
ESU (509)
SCM (454)
SCU (242)
LON (140)
QEG (318)
OLD (558)
GLO (418)
NOB (85)
UHN (739)
WRG (503)
NHH (242)
HOR (148)
HRI (538)
RBE (449)
WHH (423)
TOR (436)
RUS (485)
Of the known admission

AMT scores, 33.7% have a
score of 6 or less, consistent
with the high proportion
of patients admitted with
dementia or delirium.
WAT (455)
SHH (332)
MDW (339)
RSU (330)
PMS (376)
MAY (274)
BAR (250)
DVH (336)
ENH (443)
GWH (269)
DRY (356)
WEX (338)
MAC (246)
SAL (278)
FAZ (380)
LER (768)
IPS (436)
BAS (405)
WSH (284)
ROT (275)
DGE (373)
RED (250)
WHI (387)
HAR (286)
LGH (285)
710 (58.2%)
Unknown (12.2%)
Hospital (N)
MRI (173)
06 (29.6%)
LEW (202)
COL (520)
BOL (390)
EBH (482)
SEH (392)
BRD (350)
WGH (224)
CMI (283)
RLI (231)
BRT (293)
GHS (365)
BAT (489)
QAP (732)
WRX (266)
FRY (433)
WIR (462)
QKL (323)
QEB (414)
HUD (445)
RDE (522)
KGH (356)
BRO (346)
RVN (401)
CHE (347)
SGH (569)
GEO (164)
LDH (305)
KTH (288)
RLU (395)
CGH (286)
RCH (639)
NWG (83)
TRA (104)
FRM (365)
PGH (859)
SLF (223)
SAN (337)
WHT (144)
NMG (331)
RAD (526)
PIL (311)
MPH (368)
NOR (735)
WAR (295)
HCH (285)
JPH (340)
WHC (301)
LGI (639)
WYT (291)
PLY (570)
WWG (332)
HIL (198)
NPH (245)
WRC (412)
RSC (429)
HIN (152)
STD (208)
TUN (351)
WES (147)
YEO (190)
MKH (109)
BFH (378)
BRI (345)
WDG (284)
VIC (414)
DER (489)
MOR (534)
NUH (381)
STR (349)
CHG (299)
RFH (167)
STH (191)
LIN (293)
RVB (896)
WMU (216)
HOM (84)
GGH (248)
CRG (218)
WCI (131)
RSS (325)
GWE (352)
TLF (141)
NTH (364)
NEV (254)
GWY (228)
SOU (270)
RGH (243)
NDD (260)
WYB (144)
ALT (350)
BRG (92)
CLW (339)
KCH (114)
POW (240)
UHW (510)
RPH (390)
PCH (131)
ALL
0%
100%
20%
40%
60%
80%
100%
Chart 3b Post-operative AMT Score

0%
NICE CG 124
20%
40%
60%
80%
WDH (256)
SUN (385)
ASH (333)
PET (399)
DAR (351)
The post-operative score

is undertaken at any time
after surgery, whilst the
patient is still in the acute
ward.
NTY (308)
LON (140)
DID (371)
SHC (379)
RUS (485)
WMH (311)
KMH (344)
AEI (316)
TGA (224)
NGS (588)
PIN (530)
BLA (463)
SPH (441)
SDG (230)
COC (336)
CHS (190)
WHH (423)
DRY (356)
MAY (274)
IOW (250)
NTG (376)
FRY (433)
STM (301)
Although it would be
inappropriate to rescore a patient in some
circumstances, the vast
majority of patients should
be well enough in the days
following surgery to allow
that reassessment.
710 (50.4%)
Unknown (21.6%)
0%
GHS (365)
SCAWDH
(294)(256)
20%
40%
60%
80%
WATASH
(455)(333)
DAR
NOB
(85)(351)
BAT PIN
(489)(530)
SCMSPH
(454)(441)
COLSDG
(520)(230)
NUNCHS
(252)(190)
SMVCOC
(391)(336)
RADWHH
(526)(423)
STODRY
(595)(356)
IPS IOW
(436)(250)
BEDMAY
(176)(274)
NTG (376)
AIR (275)
HCH FRY
(285)(433)
BNTSTM
(305)(301)
FAZ BSL
(380)(168)
RHCGLO
(273)(418)
RFHWRG
(167)(503)
WEXGHS
(338)(365)
ADDNCR
(450)(367)
TRA HOR
(104)(148)
PAHSCA
(372)(294)
FGHWAT
(140)(455)
BOL QEG
(390)(318)
DVHUHN
(336)(739)
NOB (85)
LDH (305)
LERBRD
(768)(350)
SGHRSU
(569)(330)
QEQENH
(372)(443)
PMSROT
(376)(275)
RDEOLD
(522)(558)
MPHTOR
(368)(436)
RBESAL
(449)(278)
STDUHC
(208)(486)
HRISCU
(538)(242)
BRT OHM
(293) (335)
MRI BAT
(173)(489)
WSHRCH
(284)(639)
SHHCOL
(332)(520)
NMHSCM
(138)(454)
HARSMV
(286)(391)
BARNUN
(250)(252)
WYT STO
(291)(595)
EBHRAD
(482)(526)
LEWBED
(202)(176)
IPS (436)
LGH (285)
WIRHCH
(462)(285)
(275)
YDHAIR
(368)
BAS FAZ
(405)(380)
KTH BNT
(288)(305)
PILRFH
(311)(167)
(273)
GWHRHC
(269)
WARADD
(295)(450)
SLFWEX
(223)(338)
QAP PAH
(732)(372)
JPH TRA
(340)(104)
YEOBOL
(190)(390)
(336)
MDWDVH
(339)
QKL SGH
(323)(569)
DGEQEQ
(373)(372)
RVNMPH
(401)(368)
Hospital (N)
ESURDE
(509)(522)
NOR STD
(735)(208)
Unknown (21.6%)
CMI RBE
(283)(449)
BRT (293)
RLI (231)
HRI (538)
RED (250)
WHTWSH
(144)(284)
(173)
RSCMRI
(429)
NPHNMH
(245)(138)
NHHSHH
(242)(332)
SANBAR
(337)(250)
MACHAR
(246)(286)
CGHEBH
(286)(482)
WRCWYT
(412)(291)
STRLGH
(349)(285)
SEHLEW
(392)(202)
DERYDH
(489)(368)
WHC WIR
(301)(462)
VIC KTH
(414)(288)
BAS (405)
HIL (198)
GEOGWH
(164)(269)
PIL (311)
BRI (345)
CHE SLF
(347)(223)
NWGWAR
(83) (295)
BFH JPH
(378)(340)
CHGQAP
(299)(732)
LIN WHI
(293)(387)
WESYEO
(147)(190)
NMGMDW
(331)(339)
KGH RLU
(356)(395)
WMUFRM
(216)(365)
MKHQKL
(109)(323)
STH DGE
(191)(373)
WGHQEB
(224)(414)
HINESU
(152)(509)
PGHRVN
(859)(401)
CMI (283)
PLY (570)
WCINOR
(131)(735)
WDGRED
(284)(250)
RLI (231)
LGI (639)
GGHRSC
(248)(429)
HUDWHT
(445)(144)
TUNNHH
(351)(242)
NTHNPH
(364)(245)
RPHMAC
(390)(246)
BROSAN
(346)(337)
WWGWRC
(332)(412)
GWECGH
(352)(286)
HOMSEH
(84)(392)
SOU STR
(270)(349)
NDDWHC
(260)(301)
RVB DER
(896)(489)
(198)
CRGHIL
(218)
VIC (414)
WRX (266)
BRI (345)
GWY (228)
NUHGEO
(381)(164)
BRGNWG
(92) (83)
KCHCHE
(114)(347)
RSSCHG
(325)(299)
NEVBFH
(254)(378)
MORWES
(534)(147)
LIN (293)
WYB (144)
TLFKGH
(141)(356)
UHWNMG
(510)(331)
RGHMKH
(243)(109)
POWWMU
(240)(216)
CLWWGH
(339)(224)
PCHSTH
(131)(191)
PGH (859)
ALT (350)
HIN (152)
PLY (570)
ALL
WCI (131)
LGI (639)
WDG (284)
GGH (248)
HUD (445)
TUN (351)
0%
BRO (346)
WWG (332)
SOU (270)
NDD (260)
WRX (266)
22
GWY (228)
KCH (114)
RSS (325)
WYB (144)
TLF (141)
HOR (148)
QEGSUN
(318)(385)
SAL KMH
(278) (344)
(224)
OHMTGA
(335)
SCUNGS
(242)(588)
RCH BLA
(639)(463)
FRM LER
(365)(768)
QEBPMS
(414)(376)
710 (50.4%)
GLO (418)
(371)
ENHDID
(443)
TORRUS
(436)(485)
OLDWMH
(558)(311)
AEI (316)
UHC (486)
WHIFGH
(387)(140)
RLU LDH
(395)(305)
06 (28.0%)
BSL (168)
100%
NCR (367)
UHNPET
(739)(399)
RSUNTY
(330)(308)
BRDLON
(350)(140)
ROTSHC
(275)(379)
Hospital (N)
Given that BPT only applies

in England, it is a major
achievement that 78.4%
(range 0% to 100%) have
a post-operative score
06 (28.0%)
recorded.
WRG (503)
100%
20%
40%
60%
80%
NTH (364)
(390)
100%RPH
GWE (352)
HOM (84)
RVB (896)
CRG (218)
NUH (381)
BRG (92)

NEV (254)
MOR (534)
UHW (510)
RGH (243)

Chart 4 A&E to orthopaedic ward in 4 hours

(Blue Book Standard 1)
0%
20%
40%
60%
80%
WDH (256)
NICE CG 124
BFH (378)
BOL (390)
IPS (436)
KMH (344)
UHN (739)
NOB (85)
Orth ward admission

within 4 hours (48.9%)
Orth ward admission
after 4 hours (44.5%)
Not admitted to
orth ward (4.1%)
Unknown (2.5%)
Hospital (N)
The mounting pressure

on A&E departments has
impacted on hospitals
Orth ward admission
across within
the 4UK
it is not
hoursand
(48.9%)
Orth ward
admission
surprising
that
the number
after 4 hours (44.5%)
of hip Not
fracture
admitted topatients
(4.1%)
gettingorthtoward
the
appropriate
Unknown
(2.5%)
ward within four hours has
fallen from 52% to 50%.
Hospital (N)
The BOA/BGS blue book

sets out the rationale for
a team approach to hip
fracture care. One crucial
step is the rapid transfer
to the ward where the
team is based, usually an
orthopaedic ward. Patients
may be fast tracked out
of A&E within National or
local target times, but if as
a consequence they become
outliers, their overall care
may be less satisfactory.
YDH (368)
SCM (454)
QAP (732)
RCH (639)
PIL (311)
ROT (275)
NTG (376)
SAL (278)
MAC (246)
NDD (260)
RLI (231)
DER (489)
PMS (376)
WCI (131)
STH (191)
GLO (418)
RDE (522)
SEH (392)
SCU (242)
WRX (266)
HAR (286)
MRI (173)
TRA (104)
BLA (463)
WSH (284)
ENH (443)
DAR (351)
CHG (299)
CMI (283)
QEQ (372)
KGH (356)
MPH (368)
LGH (285)
LIN (293)
NMG (331)
SPH (441)
WIR (462)
PET (399)
ASH (333)
0%
SHH (332)
SDG (230)
WDH (256)
STO (595)
BOL (390)
NMH (138)
KMH (344)
WGH (224)
NOB (85)
HIL (198)
SCM (454)
NGS (588)
RCH (639)
VIC (414)
ROT (275)
WDG (284)
SAL (278)
ADD (450)
NDD (260)
BRT (293)
DER (489)
HCH (285)
WCI (131)
WAR (295)
GLO (418)
BAR (250)
SEH (392)
CHE (347)
WRX (266)
RAD (526)
MRI (173)
QKL (323)
BLA (463)
RFH (167)
ENH (443)
NTY (308)
CHG (299)
SCA (294)
QEQ (372)
CRG (218)
MPH (368)
OHM (335)
LIN (293)
SGH (569)
SPH (441)
RVN (401)
PET (399)
BSL (168)
ASH (333)
WAT (455)
SHH (332)
GWY (228)
SDG (230)
STD (208)
STO (595)
CLW (339)
NMH (138)
LGI (639)
WGH (224)
YEO (190)
HIL (198)
NOR (735)
NGS (588)
UHC (486)
VIC (414)
RSC (429)
WDG (284)
BRG (92)
ADD (450)
RSS (325)
BRT (293)
RUS (485)
HCH (285)
RVB (896)
WAR (295)
KCH (114)
BAR (250)
WHH (423)
CHE (347)
FRM (365)
RAD (526)
ESU (509)
QKL (323)
STM (301)
RFH (167)
PAH (372)
NTY (308)
SHC (379)
SCA (294)
NCR (367)
CRG (218)
PCH (131)
OHM (335)
TOR (436)
SGH (569)
PIN (530)
RVN (401)
LON (140)
BSL (168)
NWG (83)
WAT (455)
WMH (311)
GWY (228)
DVH (336)
STD (208)
LDH (305)
CLW (339)
ALT (350)
LGI (639)
BAS (405)
YEO (190)
AEI (316)
NOR (735)
WYT (291)
UHC (486)
GHS (365)
RSC (429)
NTH (364)
BRG (92)
GWE (352)
RSS (325)
GWH (269)
RUS (485)
SMV (391)
RVB (896)
MAY (274)
KCH (114)
WES (147)
WHH (423)
HOM (84)
FRM (365)
20%
40%
60%
80%
ESU (509)
ALL
RHC (273)
NUN (252)
PAH (372)
NCR (367)
PCH (131)
TOR (436)
PIN (530)
LON (140)
NWG (83)
WMH (311)
BED (176)
SUN (385)
100%
PGH (859)
HUD (445)
BFH (378)
SLF (223)
IPS (436)
GGH (248)
UHN (739)
HRI (538)
YDH (368)
QEG (318)
QAP (732)
WRC (412)
PIL (311)
SAN (337)
NTG (376)
TLF (141)
MAC (246)
TGA (224)
RLI (231)
WWG (332)
PMS (376)
SOU (270)
STH (191)
BNT (305)
RDE (522)
WYB (144)
SCU (242)
IOW (250)
HAR (286)
NHH (242)
TRA (104)
DRY (356)
WSH (284)
BRD (350)
DAR (351)
RLU (395)
CMI (283)
FGH (140)
KGH (356)
HOR (148)
LGH (285)
MDW (339)
NMG (331)
QEB (414)
WIR (462)
HIN (152)
BED (176)
RPH (390)
SUN (385)
PLY (570)
PGH (859)
AIR (275)
HUD (445)
LEW (202)
SLF (223)
DID (371)
GGH (248)
FAZ (380)
HRI (538)
COL (520)
QEG (318)
RED (250)
WRC (412)
COC (336)
SAN (337)
WMU (216)
TLF (141)
NUH (381)
TGA (224)
GEO (164)
WWG (332)
TUN (351)
SOU (270)
NPH (245)
BNT (305)
JPH (340)
WYB (144)
OLD (558)
IOW (250)
LER (768)
NHH (242)
RHC (273)
DRY (356)
NUN (252)
BRD (350)
MOR (534)
RLU (395)
CGH (286)
FGH (140)
RSU (330)
HOR (148)
WEX (338)
MDW (339)
DGE (373)
QEB (414)
BAT (489)
HIN (152)
WHT (144)
RPH (390)
NEV (254)
PLY (570)
MKH (109)
AIR (275)
RBE (449)
LEW (202)
KTH (288)
DID (371)
BRO (346)
FAZ (380)
WHC (301)
COL (520)
FRY (433)
RED (250)
WHI (387)
COC (336)
POW (240)
WMU (216)
UHW (510)
NUH (381)
BRI (345)
GEO (164)
RGH (243)
TUN (351)
EBH (482)
NPH (245)
STR (349)
JPH (340)
WRG (503)
OLD (558)
CHS (190)
LER (768)
STM (301)
SHC (379)
100%
MOR (534)
0%
20%
40%
60%
80%
CGH (286)
100%
RSU (330)
WEX (338)
DGE (373)
BAT (489)
WHT (144)
NEV (254)
MKH (109)
Copyright National Hip Fracture Database 2013.
All rights reserved.23
DVH (336)
LDH (305)
ALT (350)
BAS (405)
RBE (449)
KTH (288)
BRO (346)
Chart 5 Type of anaesthesia

0%
NICE CG 124
20%
40%
60%
80%
PGH (859)
WHH (423)
FRY (433)
SA only (29.8%)
SA + epidural (CSE) (0.5%)
SA + nerve block (8.1%)
Other (0.8%)
Unknown (7.0%)
QEB (414)
STO (595)
BRI (345)
0%
WDH (256)
ESU (509)
(380)
PGHFAZ
(859)
(305)
FRYBNT
(433)
CHS (190)
20%
40%
60%
80%
NOBMPH
(85)(368)
NUH
(381)
WHC
(301)
QEBMOR
(414)(534)
CHSWSH
(190)(284)
(285)
BRILGH
(345)
(482)
ESUEBH
(509)
(392)
WATSEH
(455)
OLDGWY
(558)(228)
WYB
(144)
WDH
(256)
RGH
(243)
FAZ
(380)
FRM
(365)
WDG
(284)
RVNHOM
(401)(84)
SCM
(454)
BNT
(305)
STMNWG
(301)(83)
(367)
BASNCR
(405)
RFH
(167)
GEO
(164)
WEX
(338)
SAL
(278)
QEQ
(372)
NDD
(260)
WIRRCH
(462)(639)
DRY
(356)
MPH
(368)
(250)
LONRED
(140)
(316)
GHS AEI
(365)
(520)
NUHCOL
(381)
UHC
(486)
MOR
(534)
(176)
RLIBED
(231)
WYT
(291)
LGH
(285)
TLF
(141)
WSH
(284)
SEHGGH
(392)(248)
(339)
EBHCLW
(482)
(283)
WYBCMI
(144)
CHG
(299)
GWY
(228)
(190)
FRMYEO
(365)
(230)
RGHSDG
(243)
(441)
SCMSPH
(454)
RSS
HOM
(84)(325)
(295)
NCRWAR
(367)
AIR
(275)
NWG
(83)
WRG
(503)
WEX
(338)
(391)
RFHSMV
(167)
(347)
RCHCHE
(639)
MKH
(109)
QEQ
(372)
(538)
REDHRI
(250)
(399)
DRYPET
(356)
COLMDW
(520)(339)
(735)
UHCNOR
(486)
TLFLEW
(141)(202)
(114)
WYTKCH
(291)
(305)
CLWLDH
(339)
NTY
(308)
GGH
(248)
WHT
(144)
CHG
(299)
HOR
(148)
CMI
(283)
NMH
(138)
SDG
(230)
(318)
YEOQEG
(190)
(768)
RSSLER
(325)
(293)
SPH LIN
(441)
(330)
AIRRSU
(275)
BRT
(293)
WAR
(295)
(436)
SMVTOR
(391)
(191)
WRGSTH
(503)
(739)
MKHUHN
(109)
CHEGWH
(347)(269)
(333)
PETASH
(399)
(274)
HRIMAY
(538)
(368)
SHCYDH
(379)
DVH
(336)
MDW
(339)
SGH
(569)
NOR
(735)
(346)
WRXBRO
(266)
(254)
KCHNEV
(114)
(349)
LEWSTR
(202)
(371)
NTYDID
(308)
(311)
LDH PIL
(305)
(250)
HORBAR
(148)
SCA
(294)
WHT
(144)
HAR
(286)
QEG
(318)
(152)
NMHHIN
(138)
(356)
LINKGH
(293)
LERBRG
(768)(92)
(418)
BRTGLO
(293)
(570)
RSUPLY
(330)
(288)
STHKTH
(191)
(530)
TORPIN
(436)
RUS
(485)
GWH
(269)
(223)
UHNSLF
(739)
WMH
(311)
MAY
(274)
(344)
ASHKMH
(333)
DVHOHM
(336)(335)
(372)
YDHPAH
(368)
(350)
BROBRD
(346)
(147)
SGHWES
(569)
STRSOU
(349)(270)
(526)
NEVRAD
(254)
(332)
PILSHH
(311)
DIDQKL
(371)(323)
(340)
SCAJPH
(294)
(250)
BARIOW
(250)
(732)
HINQAP
(152)
(364)
HARNTH
(286)
BRGFGH
(92)(140)
(131)
KGHPCH
(356)
(390)
PLYBOL
(570)
(273)
GLORHC
(418)
PINWRC
(530) (412)
(173)
KTHMRI
(288)
(489)
SLFBAT
(223)
(351)
RUSDAR
(485)
LGI
(639)
KMH
(344)
CRG
(218)
WMH
(311)
(436)
PAH IPS
(372)
SUN
(385)
OHM
(335)
PMS
(376)
WES
(147)
(104)
BRDTRA
(350)
(373)
RADDGE
(526)
(336)
SOUCOC
(270)
(252)
QKLNUN
(323)
(350)
SHHALT
(332)
GWE
(352)
IOW
(250)
JPHSCU
(340)(242)
(445)
NTHHUD
(364)
(198)
QAP HIL
(732)
(285)
PCHHCH
(131)
(131)
FGHWCI
(140)
(390)
RHCRPH
(273)
(429)
BOLRSC
(390)
MAC
(246)
MRI
(173)
NHH
(242)
WRC
(412)
(351)
DARTUN
(351)
(376)
BATNTG
(489)
UHW
(510)
CRG
(218)
LGI ENH
(639)(443)
(275)
SUNROT
(385)
(245)
IPSNPH
(436)
NMG
(331)
TRA
(104)
(208)
PMSSTD
(376)
SAN
(337)
COC
(336)
WGH
(224)
DGE
(373)
(168)
ALTBSL
(350)
(588)
NUNNGS
(252)
SCUWWG
(242)(332)
(489)
GWEDER
(352)
(463)
HILBLA
(198)
(414)
HUDVIC
(445)
(896)
WCIRVB
(131)
(224)
HCHTGA
(285)
(378)
RPHBFH
(390)
RSC (429)
ALL
NHH (242)
MAC (246)
TUN (351)
NTG (376)
NPH (245)
NMG (331)
WGH (224)
BSL (168)
DER (489)
BLA (463)
24
TGA (224)
ALL
WDG (284)
GEO
(164)
POW
(240)
(462)
RBEWIR
(449)
(140)
WHILON
(387)
(365)
ADDGHS
(450)
RLI
(231)
STO (595)
UHW (510)
WAT (455)
100%OLD (558)
RVN
(401)
WHH
(423)
(405)
RLUBAS
(395)
(301)
RDESTM
(522)
(278)
CGHSAL
(286)
NDD
(260)
WMU (216)
Hospital (N)
(7.0%)
GAUnknown
+ spinal anaesthesia
(5.7%)
WHC (301)
ADD (450)
+ nerve
block
(8.1%)
GASA
+ nerve
block
(24.7%)
(0.8%)
GAOther
+ epidural
anaesthesia (0.2%)
NOB (85)
WHI (387)
Hospital (N)
+ epidural
GASA
only
(23.0%) (CSE) (0.5%)
RBE (449)
WMU (216)
(379)
AEISHC
(316)
WRX
(266)
BED
(176)
GA + epidural anaesthesia (0.2%)
SA only (29.8%)
POW (240)
CGH (286)
GA + nerve block (24.7%)
GA + spinal anaesthesia (5.7%)
RLU (395)
RDE (522)
Since the 2012 report

the percentage of
unknowns has fallen
from 11.3% to 7%. Of
these patients 47.4%
have spinal anaesthesia,
unchanged from 2012
(47.8%). The percentage of
patients having a general
anaesthetic ranges from 2%
to 98%. The Hip fracture
ASAP sprint audit (which is
due to be published early in
2014) will further identify
how hospitals comply with
the standards of the AAGBI
guidelines.
GA only (23.0%)
100%
ENH (443)
0%
20%
40%
60%
80%
ROT (275)
STD (208)
100%
SAN (337)
NGS (588)
WWG (332)
VIC (414)
RVB (896)
BFH (378)

Time to surgery
We present three charts on time to surgery. Surgery within 36 hours of admission is a BPT criterion
whilst surgery on the day of or the day after admission is a NICE guideline and surgery within 48 hours
and during normal working hours is a Blue Book standard.
The first two charts are extremely similar, with an average compliance of 71% (up from 67% in 2012).
The range from 14% to 94% demonstrates clearly how care varies around the UK. Four of the five
hospitals with less than 40% of patients operated on within 36 hours are situated in Northern Ireland
which operates a centralised hub and spoke service.
The third chart, surgery within 48 hours and during normal working hours, excludes people who break
their hips in hospital or who remain medically unfit at 48 hours, consequently we would expect almost
100% of hospitals to comply with this standard. It is pleasing to see the average rise from 82.4 in 2012
to 85.4%, but the range shows unacceptable variation from 44% to 98%.
The reason for delay at 36 hours is now recorded for 91.3% of patients, an improvement on 85.8% in
2012.
Nationally, the cause for delay continues to be attributed evenly between medical and administrative
causes, but the percentage of delays for administrative reasons varies between different units from 0%
to 79%.
There is clearly an opportunity for providers to review their provision of trauma lists as this is by far the
commonest reason for delay accounting for 40% of known causes.
The cumulative time to theatre chart shows a consistent year on year improvement as time to theatre is
reduced across the hospitals participating in the NHFD.
There is no evidence of any generalised gaming, or suggestion that patients who are at the point
of breaching the BPT 36 hour limit are being prioritised at the expense of those who have already
breached. The variance of the curve every 24 hours appears to result from the diurnal rhythm of
admissions (which predominantly occur between 11:00 and 23:00), and of trauma operating lists
(which are mainly between 08:00 and 20:00).
The percentage of patients not treated with surgery has fallen from 2.8% in 2011 to 2.4%. The range
however is from 0% to 18%. Only one hospital (RSS) continues to treat more than 10% of its patients
non-surgically.
Chart 6 Surgery within 36 hours of admission

0%
20%
40%
60%
80%
PIL (311)
NTY (308)
SHC (379)
ASH (333)
WHT (144)
DGE (373)
DER (489)
RUS (485)
HOR (148)
SAL (278)
NMH (138)
RHC (273)
WSH (284)
FGH (140)
HIL (198)
CGH (286)
PMS (376)
FAZ (380)
UHC (486)
QAP (732)
SPH (441)
RSC (429)
ESU (509)
AIR (275)
STR (349)
KTH (288)
NGS (588)
BRT (293)
RSU (330)
BAT (489)
SCA (294)
NOR (735)
WRG (503)
NCR (367)
RVN (401)
FRY (433)
UHN (739)
KMH (344)
CHS (190)
WIR (462)
GLO (418)
WDH (256)
SUN (385)
KGH (356)
MPH (368)
CMI (283)
HAR (286)
WAR (295)
PET (399)
WAT (455)
WHI (387)
RDE (522)
GWH (269)
AEI (316)
SGH (569)
RLU (395)
PAH (372)
QEQ (372)
NTG (376)
ENH (443)
RBE (449)
NOB (85)
QKL (323)
BFH (378)
SLF (223)
LDH (305)
QEG (318)
LON (140)
MDW (339)
FRM (365)
WHH (423)
BLA (463)
ROT (275)
BAR (250)
RLI (231)
WHC (301)
WEX (338)
BNT (305)
GEO (164)
SAN (337)
SCM (454)
SDG (230)
Surgery after 36 hours (25.7%)

No operation performed (2.4%)
Unknown (0.6%)
Hospital (N)
MRI (173)
Surgery within 36 hours (71.4%)
WGH (224)
COC (336)
PGH (859)
LEW (202)
RCH (639)
LER (768)
WDG (284)
SHH (332)
DID (371)
IPS (436)
SMV (391)
WES (147)
STH (191)
LIN (293)
STO (595)
SEH (392)
BSL (168)
BRO (346)
HIN (152)
QEB (414)
HCH (285)
MKH (109)
YEO (190)
WWG (332)
MAC (246)
TUN (351)
CHE (347)
NHH (242)
CLW (339)
BED (176)
GWY (228)
SOU (270)
WMH (311)
NUN (252)
NWG (83)
OLD (558)
RED (250)
WYT (291)
BAS (405)
VIC (414)
GHS (365)
MAY (274)
NDD (260)
JPH (340)
RFH (167)
MOR (534)
DRY (356)
COL (520)
STM (301)
NEV (254)
YDH (368)
HUD (445)
PIN (530)
TRA (104)
WRX (266)
RAD (526)
TOR (436)
LGH (285)
HOM (84)
STD (208)
ADD (450)
BRD (350)
HRI (538)
EBH (482)
PLY (570)
RGH (243)
IOW (250)
WRC (412)
TGA (224)
KCH (114)
WYB (144)
DAR (351)
PCH (131)
GGH (248)
NTH (364)
TLF (141)
POW (240)
DVH (336)
BRI (345)
SCU (242)
LGI (639)
WCI (131)
WMU (216)
UHW (510)
GWE (352)
CHG (299)
BRG (92)
NMG (331)
RPH (390)
OHM (335)
BOL (390)
ALT (350)
NPH (245)
CRG (218)
RSS (325)
RVB (896)
NUH (381)
ALL
0%
26
100%
20%
40%
60%
80%
100%

Chart 7 Surgery on the day of or day after admission

0%
NICE CG 124
20%
40%
60%
80%
PIL (311)
NTY (308)
SHC (379)
WHT (144)
ASH (333)
DGE (373)
DER (489)
HOR (148)
NMH (138)
FGH (140)
HIL (198)
RHC (273)
CGH (286)
WSH (284)
SAL (278)
PMS (376)
FAZ (380)
UHC (486)
RUS (485)
QAP (732)
ESU (509)
AIR (275)
SPH (441)
KTH (288)
NCR (367)
STR (349)
NOR (735)
BRT (293)
NGS (588)
CHS (190)
SCA (294)
RSU (330)
RSC (429)
WIR (462)
UHN (739)
RVN (401)
WDH (256)
BAT (489)
GLO (418)
WAR (295)
GWH (269)
WRG (503)
CMI (283)
FRY (433)
SUN (385)
PET (399)
MPH (368)
KGH (356)
WHI (387)
PAH (372)
HAR (286)
AEI (316)
WAT (455)
QEQ (372)
KMH (344)
BFH (378)
NTG (376)
RBE (449)
SGH (569)
WEX (338)
ROT (275)
QEG (318)
NOB (85)
RLU (395)
RDE (522)
SLF (223)
QKL (323)
LDH (305)
BAR (250)
FRM (365)
LON (140)
WES (147)
SDG (230)
WHH (423)
WHC (301)
BLA (463)
BNT (305)
MDW (339)
ENH (443)
LEW (202)
WGH (224)
Surgery two or more calendar

days after admission (26.5%)
Unknown (0.5%)
SAN (337)
GEO (164)
Hospital (N)
Surgery on day of, or day

after, admission (70.6%)
SCM (454)
RLI (231)
LIN (293)
COC (336)
MRI (173)
LER (768)
WDG (284)
HIN (152)
RCH (639)
STO (595)
SHH (332)
SEH (392)
NHH (242)
YEO (190)
PGH (859)
DID (371)
HCH (285)
IPS (436)
BSL (168)
WWG (332)
STH (191)
TUN (351)
MKH (109)
BRO (346)
SMV (391)
MAC (246)
QEB (414)
BED (176)
GWY (228)
CLW (339)
NWG (83)
CHE (347)
WMH (311)
MOR (534)
VIC (414)
RED (250)
WYT (291)
OLD (558)
MAY (274)
SOU (270)
DRY (356)
JPH (340)
NEV (254)
BAS (405)
YDH (368)
GHS (365)
NUN (252)
RFH (167)
NDD (260)
PIN (530)
HUD (445)
TRA (104)
WRX (266)
HOM (84)
COL (520)
RAD (526)
STD (208)
LGH (285)
ADD (450)
RGH (243)
IOW (250)
BRD (350)
STM (301)
TOR (436)
EBH (482)
WRC (412)
TGA (224)
KCH (114)
WYB (144)
DAR (351)
PCH (131)
PLY (570)
TLF (141)
GGH (248)
WCI (131)
DVH (336)
BRI (345)
NTH (364)
POW (240)
SCU (242)
HRI (538)
WMU (216)
UHW (510)
LGI (639)
GWE (352)
BRG (92)
NMG (331)
CHG (299)
RPH (390)
OHM (335)
BOL (390)
NPH (245)
ALT (350)
CRG (218)
RSS (325)
RVB (896)
NUH (381)
ALL
0%
100%
20%
40%
60%
80%
100%
Chart 8 Surgery within 48 hours and during normal working

hours (Blue Book Standard 2)
0%
20%
40%
60%
80%
PIL (297/311)
NTY (272/308)
SHC (349/379)
ASH (306/333)
RUS (437/485)
DER (479/489)
DGE (360/373)
FAZ (350/380)
SPH (414/441)
PMS (366/376)
WRG (481/503)
RSC (411/429)
ESU (476/509)
WHT (139/144)
HIL (188/198)
RHC (250/273)
NGS (523/588)
RSU (322/330)
SDG (212/230)
FRY (396/433)
KTH (275/288)
RVN (352/401)
FGH (135/140)
BAT (463/489)
WIR (428/462)
UHC (428/486)
STR (324/349)
WGH (219/224)
CMI (278/283)
KGH (336/356)
LER (643/768)
SCA (282/294)
FRM (329/365)
GLO (399/418)
MPH (349/368)
PET (368/399)
LON (125/140)
WEX (317/338)
WHI (361/387)
HCH (267/285)
NMH (133/138)
ENH (421/443)
WAR (275/295)
BRT (273/293)
SAL (262/278)
UHN (728/739)
AEI (293/316)
PAH (358/372)
CGH (279/286)
WDH (246/256)
MRI (160/173)
SCM (414/454)
WSH (265/284)
RLU (371/395)
HOR (146/148)
HAR (270/286)
RBE (421/449)
SLF (205/223)
MKH (102/109)
GWH (255/269)
CHS (173/190)
SUN (345/385)
NHH (213/242)
BAR (222/250)
RDE (518/522)
BFH (351/378)
QEQ (358/372)
BNT (286/305)
WHC (276/301)
AIR (266/275)
QAP (724/732)
MDW (319/339)
TUN (335/351)
BRO (316/346)
NTG (350/376)
WAT (439/455)
NCR (350/367)
JPH (318/340)
KMH (326/344)
WDG (273/284)
Surgery within 48 hours but

not during working hours (0.7%)
Surgery not within
48 hours (13.4%)
Unknown (0.6%)
Hospital (n/N)
LDH (290/305)
Surgery within 48 hours &

during working hours (85.4%)
QEG (288/318)
COC (305/336)
QKL (315/323)
LIN (272/293)
BLA (423/463)
QEB (387/414)
NOR (706/735)
CLW (302/339)
WYT (260/291)
SHH (313/332)
RLI (213/231)
SMV (369/391)
SAN (318/337)
LEW (182/202)
STM (273/301)
YEO (179/190)
WHH (403/423)
STH (176/191)
CHE (335/347)
STO (566/595)
GEO (157/164)
PGH (818/859)
ROT (259/275)
IPS (413/436)
YDH (341/368)
WMH (282/311)
SOU (253/270)
RCH (604/639)
SGH (522/569)
HUD (394/445)
DRY (312/356)
BAS (375/405)
BSL (156/168)
VIC (412/414)
DID (345/371)
WRX (247/266)
WES (139/147)
COL (492/520)
RAD (489/526)
SEH (369/392)
OLD (530/558)
MAY (261/274)
MAC (229/246)
NOB (78/85)
BED (165/176)
HIN (146/152)
EBH (455/482)
WRC (390/412)
PCH (122/131)
ADD (431/450)
TOR (419/436)
GWY (211/228)
WWG (322/332)
LGH (265/285)
RFH (149/167)
NWG (76/83)
IOW (235/250)
PLY (527/570)
NEV (218/254)
TRA (95/104)
NUN (236/252)
NDD (246/260)
PIN (485/530)
HRI (504/538)
MOR (470/534)
NTH (339/364)
HOM (78/84)
BRD (308/350)
DAR (322/351)
RED (240/250)
STD (183/208)
GHS (352/365)
WMU (198/216)
RGH (226/243)
POW (222/240)
WYB (135/144)
TLF (129/141)
TGA (196/224)
GGH (235/248)
LGI (567/639)
WCI (124/131)
UHW (473/510)
NMG (299/331)
BRI (309/345)
ALT (322/350)
GWE (311/352)
SCU (220/242)
CHG (282/299)
DVH (317/336)
CRG (208/218)
KCH (113/114)
OHM (310/335)
BOL (361/390)
RSS (263/325)
NPH (233/245)
BRG (89/92)
RPH (367/390)
RVB (861/896)
NUH (338/381)
ALL
0%
100%
20%
40%
60%
80%
100%
Excludes patients known to be medically unfit, known to be admitted from

hospital or known to have not received surgery.
Excludes patients known to be medically unfit, known to be admitted from hospital or known to have not received surgery.
28

Chart 9 Reason for delay beyond 36 hours

0%
20%
40%
60%
80%
ASH (19/333)
HIN (41/152)
NTY (16/308)
BSL (38/168)
MAC (67/246)
RUS (48/485)
NMH (15/138)
GEO (37/164)
SCA (47/294)
NCR (57/367)
DID (87/371)
UHC (61/486)
NDD (77/260)
RLU (78/395)
CHS (33/190)
SUN (62/385)
AEI (53/316)
BNT (70/305)
STR (44/349)
NGS (85/588)
QEG (60/318)
WAR (57/295)
NTG (72/376)
ESU (73/509)
GWY (68/228)
SHC (20/379)
FGH (15/140)
BRG (44/92)
SAN (74/337)
STD (69/208)
QAP (104/732)
PCH (47/131)
COL (142/520)
MKH (30/109)
NOB (16/85)
LDH (64/305)
COC (66/336)
BED (50/176)
WRG (84/503)
DVH (123/336)
WMU (87/216)
STO (151/595)
WIR (73/462)
PIN (174/530)
WSH (35/284)
WES (37/147)
WMH (87/311)
SEH (102/392)
MPH (73/368)
ROT (51/275)
LER (169/768)
CLW (84/339)
GHS (118/365)
WWG (82/332)
LGI (264/639)
SDG (45/230)
EBH (171/482)
Admin/logistic awaiting
inpatient or high
dependency bed (0.5%)
PAH (69/372)
DER (53/489)
BAR (53/250)
TLF (51/141)
NUN (76/252)
ENH (89/443)
NOR (115/735)
RSC (63/429)
KMH (61/344)
WRC (141/412)
POW (97/240)
HIL (19/198)
SGH (112/569)
MRI (36/173)
WYB (52/144)
MAY (89/274)
TGA (76/224)
WHH (98/423)
Hospital (n/N)
Admin/logistic problem with

theatre/equipment (1.1%)
DGE (32/373)
SLF (48/223)
Admin/logistic awaiting
space on theatre list (36.7%)
Admin/logistic problem with

theatre/surgical/anaesthetic
staff cover (1.7%)
RBE (90/449)
KCH (18/114)
Medically unfit awaiting

orthopaedic diagnosis or
investigation (8.1%)
Admin/logistic cancelled
due to list overrun (6.1%)
SHH (81/332)
GGH (93/248)
Medically unfit awaiting

medical review investigation
or stabilisation (33.0%)
AIR (42/275)
FRM (67/365)
NHH (56/242)
GWE (162/352)
BRT (43/293)
SOU (77/270)
WYT (89/291)
RDE (105/522)
WDG (72/284)
RED (79/250)
PGH (214/859)
TRA (33/104)
CMI (52/283)
GLO (76/418)
RFH (50/167)
LEW (43/202)
BLA (103/463)
VIC (137/414)
HUD (133/445)
SMV (97/391)
NWG (22/83)
DAR (130/351)
WHI (81/387)
PLY (207/570)
STH (47/191)
WHC (67/301)
SCU (97/242)
QEB (112/414)
RSS (160/325)
RLI (55/231)
PMS (50/376)
PIL (15/311)
FAZ (45/380)
LIN (68/293)
GWH (53/269)
RVN (61/401)
Other (4.2%)
DRY (115/356)
RGH (83/243)
STM (97/301)
OLD (182/558)
NPH (130/245)
TUN (96/351)
RCH (152/639)
BRD (112/350)
Unknown (8.7%)
KTH (41/288)
BOL (217/390)
YEO (50/190)
IOW (84/250)
WAT (90/455)
QEQ (76/372)
JPH (107/340)
OHM (186/335)
HRI (192/538)
NMG (159/331)
WCI (54/131)
WRX (83/266)
QKL (72/323)
BAT (72/489)
CHG (145/299)
WGH (53/224)
UHN (127/739)
ALT (190/350)
BRO (88/346)
FRY (76/433)
HCH (70/285)
LGH (92/285)
NTH (147/364)
UHW (223/510)
SPH (63/441)
RPH (112/390)
HAR (55/286)
SCM (90/454)
WEX (74/338)
NEV (67/254)
HOR (18/148)
MDW (69/339)
YDH (110/368)
TOR (150/436)
BAS (119/405)
CRG (123/218)
RSU (52/330)
CHE (105/347)
CGH (37/286)
KGH (68/356)
NUH (306/381)
RAD (166/526)
LON (32/140)
BFH (69/378)
ADD (165/450)
WDH (36/256)
RHC (27/273)
PET (76/399)
MOR (159/534)
WHT (11/144)
SAL (33/278)
HOM (28/84)
IPS (108/436)
BRI (143/345)
RVB (649/896)
ALL
0%
100%
20%
40%
60%
80%
100%
Includes Includes
only patients
whowho
underwent
surgery
36 hours.
only patients
underwent surgery
afterafter
36 hours.
Hospitals with Hospitals
fewer than
10 patients
delayed
by by
3636hours
ormore
more
not plotted.
with fewer
than 10 patients
delayed
hours or
are are
not plotted.
100
Chart 10 Cumulative time to surgery
60
40
0
20
Cases admitted to surgery (%)
80
20122013
20112012
20102011
12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 >102
Time to surgery (hours)
Excludes cases with unknown type of surgery.
Excludes cases with unknown type of surgery.
20122013
20112012
20102011
30

Chart 11 Patients treated without surgery

0%
20%
40%
60%
80%
WHI (387)
NICE CG 124
VIC (414)
OLD (558)
KGH (356)
QKL (323)
RLI (231)
ADD (450)
HIL (198)
MPH (368)
PIL (311)
WSH (284)
WHH (423)
LON (140)
MAY (274)
RDE (522)
PGH (859)
QAP (732)
GHS (365)
KMH (344)
GWY (228)
FRY (433)
WRG (503)
CGH (286)
WDG (284)
PMS (376)
DGE (373)
SAL (278)
WAT (455)
CHE (347)
GLO (418)
BNT (305)
CHG (299)
WGH (224)
RVB (896)
SLF (223)
UHN (739)
WAR (295)
WHT (144)
RSC (429)
HAR (286)
AIR (275)
GWH (269)
PET (399)
CHS (190)
SPH (441)
NUN (252)
QEQ (372)
DER (489)
HRI (538)
DRY (356)
BED (176)
BLA (463)
SGH (569)
CMI (283)
RLU (395)
OHM (335)
ENH (443)
GEO (164)
MKH (109)
NOR (735)
NCR (367)
PLY (570)
QEB (414)
LDH (305)
HIN (152)
WHC (301)
STM (301)
TUN (351)
RCH (639)
WES (147)
SCA (294)
SMV (391)
JPH (340)
TOR (436)
STH (191)
SHH (332)
RSU (330)
NTG (376)
UHW (510)
NMH (138)
STO (595)
RBE (449)
No surgery (2.4%)
Unknown (0.5%)
Hospital (N)
PIN (530)
Surgery (97.1%)
GWE (352)
EBH (482)
IPS (436)
SEH (392)
ESU (509)
NGS (588)
WYT (291)
KTH (288)
MAC (246)
UHC (486)
NTH (364)
NTY (308)
KCH (114)
FAZ (380)
BAT (489)
SAN (337)
RUS (485)
WWG (332)
BRT (293)
BAR (250)
BOL (390)
BRI (345)
SHC (379)
WEX (338)
SOU (270)
WIR (462)
NDD (260)
BFH (378)
PAH (372)
DID (371)
RVN (401)
BRG (92)
RHC (273)
ASH (333)
POW (240)
HOR (148)
NUH (381)
DAR (351)
LGI (639)
BAS (405)
BRO (346)
NOB (85)
WMH (311)
MDW (339)
FGH (140)
RFH (167)
NMG (331)
SUN (385)
YEO (190)
RGH (243)
MOR (534)
LIN (293)
TRA (104)
STD (208)
LER (768)
AEI (316)
CRG (218)
SCU (242)
ALT (350)
STR (349)
WRC (412)
IOW (250)
QEG (318)
LEW (202)
WRX (266)
HCH (285)
WCI (131)
PCH (131)
MRI (173)
SCM (454)
HOM (84)
RED (250)
GGH (248)
YDH (368)
COC (336)
WMU (216)
HUD (445)
SDG (230)
LGH (285)
CLW (339)
TGA (224)
BRD (350)
ROT (275)
WDH (256)
FRM (365)
NPH (245)
BSL (168)
COL (520)
NHH (242)
WYB (144)
NWG (83)
DVH (336)
NEV (254)
TLF (141)
RAD (526)
RSS (325)
RPH (390)
ALL
0%
100%
20%
40%
60%
80%
100%
Operations performed by fracture type

Chart 12 Undisplaced intracapsular fractures
0%
NICE CG124 and the Blue

Book recommend internal
fixation of undisplaced
intracapsular fractures.
The percentage of patients
having an internal fixation
has risen from 49.1% in
2012 to 49.9%. There
remains some doubt as to
whether or not this is due
to misclassification of the
fractures.
20%
40%
60%
80%
BRD (134/350)
NUN (27/252)
HIL (41/198)
SOU (55/270)
SAL (14/278)
QEB (112/414)
WHT (39/144)
WHH (58/423)
WYB (24/144)
GWH (20/269)
RSC (79/429)
WDG (70/284)
SPH (21/441)
WGH (77/224)
DVH (43/336)
STH (33/191)
RLI (56/231)
ENH (125/443)
NTG (23/376)
GEO (16/164)
AIR (40/275)
SGH (95/569)
RCH (71/639)
MAC (26/246)
DGE (36/373)
RSU (11/330)
HCH (76/285)
PCH (16/131)
PLY (37/570)
BAR (21/250)
FGH (26/140)
QEQ (57/372)
TUN (32/351)
SDG (48/230)
SMV (54/391)
GWE (49/352)
TOR (23/436)
MDW (39/339)
SCM (41/454)
FRY (20/433)
LIN (31/293)
SCA (46/294)
MOR (97/534)
DID (79/371)
TLF (17/141)
MRI (141/173)
SCU (21/242)
ALT (44/350)
GGH (25/248)
BSL (29/168)
WYT (31/291)
HIN (33/152)
Arthroplasty
Unipolar hemi (cemented) (23.1%)
Arthroplasty
Unipolar hemi (uncemented) (5.8%)
Arthroplasty
Bipolar hemi (cemented) (7.7%)
Internal fixation
Screws (29.2%)
Other (0.9%)
NPH (10/245)
LEW (10/202)
FAZ (47/380)
WRG (35/503)
OLD (54/558)
YEO (19/190)
WSH (19/284)
SEH (38/392)
KGH (32/356)
NEV (28/254)
STR (26/349)
RUS (40/485)
RDE (29/522)
WDH (38/256)
LGI (134/639)
NMG (35/331)
WES (12/147)
Hospital (n/N)
Internal fixation
SHS (20.7%)
RVB (43/896)
NWG (14/83)
NOB (11/85)
Arthroplasty
Other (7.3%)
KTH (22/288)
ESU (50/509)
BLA (25/463)
RAD (45/526)
PIL (28/311)
CRG (28/218)
KMH (46/344)
RBE (34/449)
COC (34/336)
YDH (24/368)
IOW (16/250)
WIR (43/462)
BRO (19/346)
BRT (30/293)
PIN (11/530)
VIC (83/414)
JPH (31/340)
WAR (34/295)
DAR (20/351)
NUH (29/381)
RGH (38/243)
COL (66/520)
WMH (12/311)
QEG (12/318)
Unknown (0.2%)
BAT (28/489)
STO (16/595)
SAN (77/337)
MAY (29/274)
POW (26/240)
NGS (13/588)
NOR (52/735)
LER (72/768)
DRY (23/356)
CHG (23/299)
HRI (76/538)
UHW (57/510)
OHM (74/335)
WRX (31/266)
CGH (31/286)
QAP (52/732)
GHS (52/365)
WMU (14/216)
HAR (40/286)
RHC (22/273)
AEI (26/316)
QKL (26/323)
NDD (34/260)
WHI (24/387)
ASH (16/333)
SHC (12/379)
WWG (25/332)
WHC (57/301)
LON (18/140)
LGH (18/285)
NHH (14/242)
WAT (34/455)
PGH (44/859)
SHH (25/332)
RLU (20/395)
BRI (31/345)
WRC (26/412)
RPH (27/390)
NCR (23/367)
CLW (23/339)
BOL (35/390)
ROT (24/275)
DER (31/489)
LDH (19/305)
NTH (20/364)
IPS (34/436)
PMS (50/376)
PET (37/399)
ADD (40/450)
RFH (18/167)
MPH (28/368)
FRM (94/365)
STD (10/208)
WEX (11/338)
SLF (25/223)
BAS (39/405)
HUD (49/445)
CMI (20/283)
PAH (22/372)
UHC (54/486)
BFH (31/378)
EBH (37/482)
RSS (45/325)
RED (15/250)
NTY (15/308)
GLO (25/418)
CHE (31/347)
ALL
0%
100%
20%
40%
60%
80%
100%
Hospitals with less than 10 cases with an undisplaced intracapsular fracture are excluded.
Hospitals with less than 10 cases with an undisplaced intercapsular fracture are excluded.
32

Chart 13 Displaced intracapsular fractures

0%
NICE CG 124
20%
40%
60%
80%
KMH (168/344)
GHS (125/365)
RAD (221/526)
WCI (62/131)
There has been a slight

fall in the percentage
of patients having an
arthroplasty from 93% to
90.1%.
PGH (482/859)
CHE (172/347)
QKL (166/323)
LDH (166/305)
LON (54/140)
CMI (153/283)
PMS (193/376)
KTH (134/288)
CHS (84/190)
HOM (41/84)
MAC (40/246)
WRG (262/503)
CHG (148/299)
PAH (178/372)
SPH (211/441)
TOR (210/436)
DGE (168/373)
WDG (94/284)
MAY (125/274)
BAR (121/250)
TUN (177/351)
NTG (200/376)
SLF (111/223)
LGH (130/285)
MKH (51/109)
STO (329/595)
RBE (242/449)
WMH (166/311)
WEX (163/338)
NCR (184/367)
SMV (156/391)
NTH (174/364)
HIN (65/152)
YDH (186/368)
FRM (184/365)
NMG (142/331)
PLY (320/570)
STD (98/208)
SUN (232/385)
STH (77/191)
BFH (184/378)
WWG (165/332)
WSH (143/284)
BED (88/176)
ASH (176/333)
RHC (156/273)
NMH (69/138)
ENH (135/443)
FRY (234/433)
SOU (117/270)
RDE (280/522)
RPH (146/390)
NOR (373/735)
DRY (178/356)
WHH (177/423)
RFH (64/167)
BRG (48/92)
SAL (151/278)
STR (165/349)
CLW (149/339)
Arthroplasty
Unipolar hemi (cemented) (43.1%)
Arthroplasty
Unipolar hemi (uncemented) (13.6%)
Arthroplasty
Other (14.4%)
Internal fixation
SHS (4.7%)
Internal fixation
Screws (2.3%)
Other (0.7%)
WHT (44/144)
JPH (161/340)
GEO (73/164)
SCM (229/454)
IOW (127/250)
BAT (253/489)
KGH (168/356)
RLI (83/231)
CRG (110/218)
ESU (246/509)
BRT (121/293)
EBH (214/482)
WHC (147/301)
IPS (213/436)
Hospital (n/N)
Arthroplasty
Bipolar hemi (cemented) (19.0%)
HAR (132/286)
BOL (197/390)
NDD (105/260)
SHC (210/379)
QAP (354/732)
COC (168/336)
WAT (218/455)
ALT (153/350)
BAS (212/405)
RSU (186/330)
RGH (86/243)
RVB (515/896)
PIL (169/311)
WHI (193/387)
BRD (48/350)
UHW (236/510)
DAR (177/351)
RVN (200/401)
FAZ (176/380)
HUD (198/445)
NTY (174/308)
STM (150/301)
SHH (172/332)
PCH (55/131)
LER (372/768)
SCA (140/294)
WAR (149/295)
RLU (201/395)
GWY (116/228)
MOR (198/534)
WRX (122/266)
BRI (160/345)
NUN (119/252)
WES (59/147)
Unknown (0.1%)
BRO (175/346)
SCU (123/242)
AEI (140/316)
MDW (158/339)
LGI (277/639)
QEG (175/318)
HCH (97/285)
RSC (158/429)
SGH (254/569)
RCH (296/639)
SEH (191/392)
POW (112/240)
DER (239/489)
LIN (144/293)
WIR (218/462)
YEO (90/190)
CGH (147/286)
RED (100/250)
QEB (114/414)
WGH (68/224)
AIR (105/275)
ADD (225/450)
LEW (111/202)
HIL (66/198)
UHC (218/486)
ROT (152/275)
VIC (159/414)
NHH (127/242)
HRI (288/538)
DVH (124/336)
FGH (55/140)
WDH (103/256)
PIN (297/530)
SDG (82/230)
QEQ (143/372)
RUS (244/485)
WRC (219/412)
HOR (78/148)
WYT (148/291)
COL (266/520)
UHN (420/739)
TLF (68/141)
NEV (118/254)
OHM (159/335)
NOB (37/85)
BNT (156/305)
NUH (211/381)
KCH (61/114)
RSS (140/325)
GWE (173/352)
WYB (65/144)
NWG (26/83)
NGS (344/588)
PET (192/399)
MPH (178/368)
WMU (116/216)
NPH (114/245)
BLA (213/463)
DID (132/371)
SAN (94/337)
BSL (36/168)
OLD (322/558)
GGH (119/248)
GWH (149/269)
TGA (153/224)
ALL
0%
100%
TRA (28/104)
GLO (221/418)
20%
40%
60%
80%
100%
Hospitals withHospitals
less than
10 cases with a displaced intracapsular fracture are excluded.
with less than 10 cases with a displaced intercapsular fracture are excluded.
Chart 14 Cementing of arthroplasties
0%
NICE CG 124
20%
40%
60%
80%
WES (58/147)
PET (151/399)
MKH (54/109)
This is recommended in
NICE CG 124 and the rate
has risen from 63% in 2010
to 77.2% in 2013. The
range is from 3% to 100%.
KCH (54/114)
GEO (81/164)
BRT (125/293)
BOL (189/390)
ASH (170/333)
ALT (167/350)
RDE (278/522)
SCM (238/454)
FRY (234/433)
TOR (217/436)
IPS (202/436)
RVB (497/896)
QEG (164/318)
BRI (151/345)
WDG (146/284)
WGH (117/224)
NDD (107/260)
LEW (104/202)
NPH (96/245)
UHC (191/486)
NTY (159/308)
DER (216/489)
NGS (280/588)
MPH (138/368)
HOR (65/148)
RVN (188/401)
RAD (240/526)
SGH (298/569)
POW (109/240)
WSH (147/284)
PMS (196/376)
BRG (48/92)
KTH (141/288)
NUH (180/381)
YEO (89/190)
WIR (212/462)
SAL (154/278)
SLF (109/223)
LER (362/768)
PIL (170/311)
VIC (169/414)
MAC (127/246)
IOW (125/250)
BRD (171/350)
QKL (170/323)
ADD (202/450)
PLY (327/570)
STR (168/349)
TGA (98/224)
STD (94/208)
UHW (235/510)
LGI (306/639)
TUN (194/351)
DVH (154/336)
FAZ (184/380)
MOR (234/534)
UHN (348/739)
RSU (181/330)
DRY (177/356)
WYT (143/291)
CGH (141/286)
RCH (310/639)
STM (138/301)
BLA (168/463)
ROT (136/275)
SHH (166/332)
COL (244/520)
CRG (113/218)
BED (84/176)
QEB (200/414)
CMI (151/283)
SUN (223/385)
HCH (135/285)
SDG (98/230)
NUN (133/252)
SCA (156/294)
RSC (202/429)
Uncemented (22.8%)
Hospital (n/N)
AIR (126/275)
Cemented (77.2%)
MRI (79/173)
COC (169/336)
WHC (155/301)
RFH (62/167)
AEI (133/316)
DAR (172/351)
HOM (42/84)
DGE (186/373)
RLU (189/395)
HIL (94/198)
HAR (133/286)
SEH (191/392)
WRG (273/503)
GWE (166/352)
NHH (112/242)
PGH (483/859)
BFH (175/378)
LGH (133/285)
WAT (209/455)
BAT (247/489)
CHG (153/299)
JPH (163/340)
SHC (197/379)
MAY (132/274)
WMH (165/311)
RPH (144/390)
HRI (270/538)
GWY (107/228)
WYB (70/144)
GGH (100/248)
RHC (153/273)
ESU (260/509)
NWG (29/83)
KGH (181/356)
GLO (220/418)
LDH (166/305)
WMU (92/216)
MDW (163/339)
WRX (119/266)
RLI (117/231)
DID (160/371)
OHM (156/335)
RUS (222/485)
NOR (367/735)
ENH (215/443)
GWH (110/269)
SMV (181/391)
NOB (36/85)
TRA (44/104)
YDH (187/368)
BSL (57/168)
SOU (160/270)
NMG (150/331)
LON (57/140)
SCU (123/242)
NTH (187/364)
WRC (188/412)
WEX (158/338)
WDH (117/256)
NTG (212/376)
QEQ (178/372)
WHH (232/423)
RGH (94/243)
BAS (199/405)
STH (96/191)
CHE (169/347)
BRO (164/346)
PAH (174/372)
WWG (166/332)
FRM (185/365)
LIN (145/293)
CLW (146/339)
HUD (185/445)
SAN (136/337)
PIN (256/530)
OLD (249/558)
TLF (66/141)
NEV (111/254)
RSS (111/325)
BAR (130/250)
QAP (343/732)
HIN (79/152)
CHS (84/190)
GHS (142/365)
FGH (67/140)
NCR (180/367)
RED (87/250)
WHI (184/387)
EBH (202/482)
KMH (185/344)
WCI (61/131)
STO (322/595)
BNT (124/305)
SPH (222/441)
WAR (147/295)
NMH (66/138)
WHT (73/144)
RBE (247/449)
PCH (61/131)
ALL
0%
100%
20%
40%
60%
80%
100%
Includes
allallpatients
who
underwent
arthroplasty.
Includes
patients who
underwent
arthroplasty.
34

Chart 15 Total hip replacement for displaced intracapsular

fractures
0%
20%
40%
60%
80%
NMH (19/138)
STH (44/191)
NTH (53/364)
NICE CG 124
NHH (40/242)
HOM (10/84)
GLO (77/418)
RAD (60/526)
SOU (13/270)
SGH (71/569)
PMS (81/376)
SUN (68/385)
The percentage has risen

from 10.7% in 2011 to
20.7% in 2013, a very
swift response to clinical
guidance.
QEB (25/414)
WSH (62/284)
NCR (49/367)
STR (57/349)
NMG (54/331)
DVH (54/336)
BRI (73/345)
SAN (34/337)
LGH (37/285)
WRX (32/266)
WES (32/147)
SLF (40/223)
RBE (93/449)
WCI (11/131)
DGE (82/373)
WDG (34/284)
GHS (34/365)
LIN (43/293)
QKL (41/323)
RDE (136/522)
RSC (71/429)
LON (12/140)
HCH (27/285)
CHG (70/299)
TOR (65/436)
BOL (88/390)
RLU (79/395)
MKH (19/109)
ROT (51/275)
SHH (48/332)
WRG (91/503)
CHE (46/347)
HAR (56/286)
COC (56/336)
SPH (80/441)
SMV (50/391)
NGS (97/588)
WEX (54/338)
NTG (61/376)
PIN (119/530)
HIN (24/152)
STD (31/208)
WHH (76/423)
SCA (57/294)
RHC (61/273)
QEG (58/318)
AIR (44/275)
STO (112/595)
BLA (73/463)
WAR (62/295)
FRY (97/433)
WHI (74/387)
FAZ (59/380)
WGH (20/224)
GEO (12/164)
RCH (129/639)
CGH (65/286)
FRM (87/365)
RVN (72/401)
AEI (47/316)
QAP (120/732)
SEH (69/392)
ENH (65/443)
Other operation (79.3%)
Hospital (n/N)
EBH (65/482)
Total hip replacement (20.7%)
GWE (42/352)
ADD (90/450)
RGH (19/243)
PAH (63/372)
RVB (112/896)
DAR (54/351)
NDD (25/260)
BAT (108/489)
BAR (31/250)
WMH (48/311)
STM (59/301)
MOR (86/534)
BAS (86/405)
WWG (44/332)
WIR (66/462)
KTH (67/288)
YDH (85/368)
LGI (97/639)
ASH (46/333)
LDH (64/305)
IOW (41/250)
PIL (59/311)
TUN (42/351)
RED (48/250)
RSU (55/330)
WDH (31/256)
HRI (124/538)
TLF (25/141)
SAL (82/278)
OHM (64/335)
MPH (71/368)
UHC (91/486)
MAC (13/246)
KMH (74/344)
GGH (27/248)
BFH (41/378)
RSS (37/325)
QEQ (52/372)
JPH (61/340)
NEV (46/254)
PLY (127/570)
SDG (32/230)
DER (104/489)
ESU (89/509)
KGH (42/356)
HOR (26/148)
MDW (71/339)
YEO (18/190)
RFH (27/167)
MAY (63/274)
BRO (72/346)
SCM (74/454)
BED (37/176)
WHC (56/301)
CRG (38/218)
RLI (29/231)
RUS (101/485)
PGH (202/859)
WYT (71/291)
WRC (73/412)
NOR (181/735)
NUH (54/381)
UHN (133/739)
NTY (67/308)
HIL (23/198)
SHC (73/379)
CMI (49/283)
COL (103/520)
CLW (13/339)
BRT (54/293)
VIC (68/414)
WAT (100/455)
GWH (43/269)
WMU (60/216)
FGH (15/140)
LER (118/768)
CHS (34/190)
DRY (73/356)
OLD (172/558)
BNT (58/305)
SCU (34/242)
DID (43/371)
NPH (45/245)
NUN (49/252)
LEW (50/202)
PET (69/399)
WYB (16/144)
WHT (14/144)
TGA (51/224)
NWG (10/83)
IPS (70/436)
HUD (80/445)
ALT (13/350)
ALL
0%
100%
20%
40%
60%
80%
100%
Eligible cases: displaced intracapsular

fracture,
able to fracture,
walk outdoors
no with
aidsnooraids
one
aid,aid,
pre-operative
AMTS
greater
Eligible cases: displaced
intracapsular
able to walkwith
outdoors
or one
preoperative AMTS
greater
than 7,than 7,
ASA Grade of 3 orASA
lessGrade
and ofreceived
an received
operation.
Hospitals
withwith
lessless
than
eligible
cases
are excluded.
3 or less and
an operation.
Hospitals
than 10
10 eligible
cases
are excluded.
Chart 16 Intertrochanteric fractures

0%
NICE CG 124
20%
40%
60%
80%
PIL (96/311)
RPH (87/390)
QKL (109/323)
MPH (131/368)
KMH (108/344)
HRI (150/538)
HOR (55/148)
There has been a shift in the

proportion of long to short,
intramedullary nails, with
long nails now being used
60% of the time compared
with 54% in 2012.
HOM (34/84)
CHE (120/347)
BED (57/176)
ADD (164/450)
WRG (167/503)
STH (70/191)
KCH (36/114)
HAR (93/286)
BLA (202/463)
IPS (170/436)
ENH (159/443)
PAH (157/372)
OLD (156/558)
VIC (152/414)
WHI (147/387)
WAT (147/455)
QAP (289/732)
SHC (141/379)
ASH (118/333)
NTY (115/308)
STO (227/595)
RED (110/250)
MAY (102/274)
WSH (101/284)
PGH (301/859)
WRX (98/266)
SPH (196/441)
WAR (94/295)
CHG (89/299)
SCU (88/242)
CHS (83/190)
RHC (83/273)
GWY (83/228)
RLI (82/231)
NOR (242/735)
NTH (79/364)
DGE (145/373)
SLF (72/223)
NCR (143/367)
BFH (138/378)
POW (68/240)
WEX (133/338)
WGH (62/224)
GWH (62/269)
RVN (123/401)
STM (121/301)
NGS (181/588)
LON (60/140)
TOR (178/436)
BAT (177/489)
MAC (58/246)
RDE (170/522)
GHS (170/365)
WWG (112/332)
PMS (111/376)
ESU (161/509)
UHN (263/739)
TGA (52/224)
PET (156/399)
LGH (101/285)
FRY (148/433)
SAL (98/278)
Arthroplasty (1.2%)
Other (0.5%)
Unknown (0.1%)
MKH (47/109)
NUN (94/252)
DRY (139/356)
IOW (92/250)
WYT (90/291)
SDG (90/230)
HIN (45/152)
FAZ (134/380)
Hospital (n/N)
Internal fixation
Screws (0.3%)
WHT (47/144)
RAD (188/526)
Internal fixation
IM nail (long) (7.1%)
Internal fixation
IM nail (short) (4.8%)
UHC (194/486)
RLU (145/395)
Internal fixation
SHS (84.2%)
PLY (176/570)
BRI (130/345)
DER (171/489)
SUN (128/385)
RCH (209/639)
RUS (163/485)
UHW (198/510)
RVB (313/896)
BRG (39/92)
HUD (155/445)
RSC (150/429)
WRC (148/412)
PIN (184/530)
FRM (71/365)
BNT (106/305)
NTG (138/376)
JPH (137/340)
RBE (136/449)
LIN (102/293)
MDW (132/339)
WCI (64/131)
GWE (96/352)
COC (128/336)
SGH (191/569)
SMV (159/391)
AEI (127/316)
NDD (94/260)
HIL (62/198)
WES (60/147)
LDH (90/305)
NMH (59/138)
MOR (206/534)
LER (291/768)
NOB (29/85)
CGH (86/286)
SHH (111/332)
GLO (165/418)
ROT (82/275)
GEO (54/164)
KTH (106/288)
SCM (159/454)
YDH (132/368)
WIR (158/462)
BOL (130/390)
RFH (77/167)
EBH (204/482)
KGH (126/356)
CMI (97/283)
BAR (96/250)
QEB (165/414)
DAR (117/351)
WMH (117/311)
WMU (69/216)
NUH (137/381)
BRO (133/346)
BRT (131/293)
CRG (65/218)
SEH (129/392)
LEW (64/202)
MRI (21/173)
NHH (82/242)
STD (82/208)
BRD (123/350)
LGI (180/639)
STR (139/349)
TUN (119/351)
BAS (134/405)
NMG (132/331)
RSU (113/330)
HCH (91/285)
SOU (72/270)
RGH (90/243)
COL (151/520)
TRA (33/104)
SCA (92/294)
ALT (133/350)
OHM (85/335)
FGH (42/140)
AIR (110/275)
QEG (120/318)
YEO (66/190)
NEV (91/254)
CLW (143/339)
WHC (72/301)
WDG (106/284)
QEQ (133/372)
WHH (149/423)
NWG (31/83)
WYB (40/144)
TLF (43/141)
NPH (111/245)
PCH (51/131)
WDH (83/256)
DID (126/371)
DVH (138/336)
RSS (120/325)
BSL (96/168)
SAN (129/337)
GGH (52/248)
ALL
0%
100%
20%
40%
60%
80%
100%
Hospitals with less than 10 cases with an intertrochanteric fracture are excluded.
Hospitals with less than 10 cases with an intertrochanteric fracture are excluded.
36

Chart 17 Subtrochanteric fractures

0%
NICE CG 124
20%
40%
60%
80%
WHI (22/387)
SGH (18/569)
HIL (28/198)
BFH (24/378)
WRX (15/266)
WMH (14/311)
VIC (19/414)
The percentage of long

intramedullary nails has
risen from 63.6% in 2012
to 70.6% in keeping with
NICE CG 124 guidance.
UHC (20/486)
TUN (20/351)
SUN (10/385)
STM (20/301)
STH (11/191)
SMV (22/391)
SLF (15/223)
SHC (16/379)
SDG (10/230)
SCM (25/454)
SCA (11/294)
SAL (15/278)
RUS (38/485)
RSU (20/330)
RLU (28/395)
RLI (10/231)
RHC (12/273)
RED (15/250)
QKL (20/323)
QEB (20/414)
QAP (35/732)
PMS (22/376)
PLY (37/570)
PET (14/399)
PAH (15/372)
OHM (14/335)
NUN (10/252)
NTG (11/376)
NPH (10/245)
NOR (61/735)
NMG (14/331)
NDD (21/260)
MPH (29/368)
LGI (45/639)
LER (32/768)
KTH (23/288)
Internal fixation
SHS (21.0%)
GWY (19/228)
GWH (16/269)
GHS (18/365)
ENH (21/443)
Internal fixation
IM nail (long) (70.6%)
EBH (26/482)
DRY (16/356)
CRG (15/218)
CLW (23/339)
CHE (19/347)
BRT (11/293)
Internal fixation
IM nail (short) (3.5%)
BOL (28/390)
BNT (33/305)
BED (16/176)
AIR (18/275)
Internal fixation
Screws (0.1%)
ADD (19/450)
WIR (42/462)
WHT (12/144)
TOR (24/436)
STR (19/349)
IPS (19/436)
Arthroplasty (0.8%)
HAR (21/286)
BRI (24/345)
BAR (12/250)

Unknown (0.2%)
Hospital (n/N)
WAT (55/455)
Other (1.7%)
100%
UHN (50/739)
RDE (42/522)
LDH (30/305)
ESU (30/509)
COL (28/520)
FRY (28/433)
RAD (27/526)
NGS (27/588)
RVN (52/401)
OLD (26/558)
RVB (25/896)
FAZ (23/380)
DAR (23/351)
RGH (22/243)
STO (22/595)
SOU (22/270)
HRI (22/538)
WEX (21/338)
RCH (62/639)
HUD (40/445)
ALT (20/350)
NHH (19/242)
BRO (19/346)
CHG (37/299)
WAR (18/295)
PIN (36/530)
WYT (18/291)
WRC (18/412)
UHW (18/510)
WSH (16/284)
WES (16/147)
PGH (32/859)
NTH (16/364)
NCR (16/367)
DER (48/489)
MOR (31/534)
PIL (15/311)
IOW (15/250)
DVH (15/336)
CHS (15/190)
WDG (14/284)
NEV (14/254)
LIN (14/293)
STD (13/208)
CMI (13/283)
YDH (25/368)
RBE (37/449)
KGH (12/356)
SPH (12/441)
GWE (24/352)
BLA (12/463)
RSC (35/429)
DGE (23/373)
WDH (11/256)
KMH (22/344)
ASH (21/333)
AEI (21/316)
CGH (21/286)
WRG (30/503)
SEH (30/392)
MDW (10/339)
BAS (20/405)
LGH (29/285)
MAY (18/274)
SAN (17/337)
GEO (17/164)
WMU (16/216)
RPH (24/390)
POW (27/240)
QEQ (26/372)
HCH (19/285)
WYB (12/144)
DID (28/371)
BAT (22/489)
ROT (16/275)
WWG (26/332)
LEW (10/202)
SHH (19/332)
TLF (11/141)
WHH (32/423)
RSS (17/325)
ALL
0%
20%
40%
60%
80%
100%
Hospitals with less than 10 cases with a subtrochanteric fracture are excluded.
Hospitals with less than 10 cases with a subtrochanteric fracture are excluded.
Chart 18 Development of pressure ulcers

0%
NICE CG 124
20%
40%
60%
80%
MAY (242/274)
DVH (299/336)
NUN (225/252)
QEB (380/414)
WIR (419/462)
WES (141/147)
HOM (79/84)
RVN (375/401)
NCR (348/367)
The incidence of pressure

ulcers has fallen from 3.7%
in 2012 to 3.3%, with a
further fall in unknowns
showing that surveillance
for pressure ulcers has
improved in the majority of
hospitals.
CRG (205/218)
WGH (212/224)
GGH (219/248)
RSC (409/429)
SPH (416/441)
QEG (272/318)
COC (300/336)
NTG (352/376)
WMU (198/216)
YEO (176/190)
SEH (373/392)
GEO (150/164)
SAN (304/337)
LDH (262/305)
EBH (448/482)
MKH (94/109)
WHH (361/423)
ALT (332/350)
FGH (128/140)
BRI (305/345)
NGS (523/588)
NOR (677/735)
FRY (381/433)
NDD (234/260)
CHS (170/190)
NMH (120/138)
JPH (311/340)
CLW (297/339)
SCM (413/454)
LER (713/768)
VIC (388/414)
PAH (336/372)
NHH (219/242)
RUS (440/485)
TUN (323/351)
GHS (325/365)
NUH (355/381)
RLI (211/231)
BRG (87/92)
WEX (306/338)
MRI (154/173)
SUN (331/385)
STD (181/208)
RSU (297/330)
SHC (329/379)
ADD (423/450)
CGH (261/286)
WHC (273/301)
BAR (227/250)
LGH (255/285)
WYB (128/144)
NWG (77/83)
PMS (336/376)
STO (569/595)
WSH (266/284)
NMG (293/331)
SDG (216/230)
KGH (325/356)
PCH (110/131)
SCA (280/294)
PIN (485/530)
NTH (315/364)
ESU (460/509)
SHH (288/332)
RAD (490/526)
BOL (349/390)
WCI (117/131)
HAR (266/286)
OHM (309/335)
DGE (342/373)
AEI (281/316)
No pressure ulcers (91.4%)

Unknown (5.3%)
Hospital (n/N)
WDG (266/284)
Pressure ulcers (3.3%)
AIR (254/275)
BLA (404/463)
ASH (297/333)
COL (483/520)
DER (489/489)
BRO (306/346)
MOR (463/534)
OLD (512/558)
SGH (516/569)
RHC (248/273)
POW (213/240)
GWE (307/352)
WAR (267/295)
STH (178/191)
KTH (271/288)
WHT (136/144)
BRT (272/293)
HOR (137/148)
WMH (275/311)
SLF (200/223)
QKL (305/323)
PGH (823/859)
KCH (103/114)
RBE (415/449)
WYT (263/291)
GLO (371/418)
NEV (215/254)
GWY (215/228)
CHE (323/347)
BNT (284/305)
WRX (236/266)
ROT (243/275)
MDW (309/339)
BAS (371/405)
HCH (256/285)
UHN (667/739)
CHG (276/299)
NTY (282/308)
HIN (141/152)
PIL (286/311)
LGI (574/639)
BFH (364/378)
NPH (221/245)
RSS (303/325)
RFH (154/167)
QAP (696/732)
NOB (80/85)
TOR (403/436)
RDE (497/522)
RCH (594/639)
BAT (444/489)
TRA (91/104)
WWG (290/332)
HUD (401/445)
WAT (403/455)
STR (306/349)
DAR (308/351)
RVB (837/896)
DRY (317/356)
UHC (440/486)
MPH (332/368)
QEQ (334/372)
MAC (223/246)
RED (224/250)
IOW (224/250)
SCU (225/242)
RPH (354/390)
WDH (240/256)
SAL (250/278)
ENH (394/443)
CMI (271/283)
LIN (275/293)
BSL (145/168)
BRD (299/350)
UHW (451/510)
KMH (310/344)
BED (164/176)
DID (343/371)
FAZ (345/380)
YDH (349/368)
RLU (361/395)
HIL (183/198)
LEW (184/202)
PET (371/399)
WRC (376/412)
TGA (201/224)
RGH (211/243)
WRG (450/503)
HRI (497/538)
GWH (253/269)
FRM (321/365)
WHI (337/387)
SMV (360/391)
IPS (404/436)
TLF (134/141)
STM (275/301)
SOU (251/270)
PLY (533/570)
LON (127/140)
ALL
0%
100%
20%
40%
60%
80%
100%
Excludes cases who died in hospital.

Excludes cases that died in hospital.
38

Chart 19 Pre-operative medical assessments

Routine by specialist
nurse (8.3%)
Medical review following
request (2.0%)
0%
20%
40%
60%
80%
GWH (269)
TGA (224)
ROT (275)
QAP (732)
PLY (570)
PGH (859)
PET (399)
PAH (372)
MAC (246)
FRM (365)
FGH (140)
BRD (350)
RGH (243)
BSL (168)
KMH (344)
RSS (325)
BNT (305)
STM (301)
RHC (273)
UHC (486)
TOR (436)
CRG (218)
BFH (378)
MDW (339)
WES (147)
HRI (538)
UHN (739)
CHE (347)
SAN (337)
RED (250)
SAL (278)
VIC (414)
RVB (896)
OHM (335)
LDH (305)
NMH (138)
WWG (332)
WAT (455)
HOM (84)
RUS (485)
ENH (443)
NPH (245)
SHC (379)
BAT (489)
LER (768)
BAR (250)
STD (208)
0%
WHC (301)
GWH(83)
(269)
NWG
20%
40%
60%
80%
WYT
(291)
GHS
(365)
ROT
(275)
SHH
(332)
BSL(510)
(168)
UHW
RSS
(325)
COC
(336)
BNT
(305)
WSH
(284)
RHC
(273)
HUD
(445)
STM
(301)
KTH
(288)
UHC
(486)
PIN
(530)
TOR
(436)
QEB
(414)
BFH
(378)
STR
(349)
CRG
(218)
PCH
(131)
MDW
(339)
LGI
(639)
WES
(147)
LEW
(202)
UHN
(739)
NUH
(381)
HRI(372)
(538)
QEQ
CHE
(347)
BAS
(405)
SAN
(337)
HIL
(198)
SAL
(278)
OLD
(558)
RED
(250)
TRA
(104)
VIC(441)
(414)
SPH
RVB
(896)
RBE
(449)
LDH
(305)
DVH
(336)
OHM
(335)
RLU
(395)
NMH
(138)
SCU
(242)
WWG
(332)
SEH
(392)
HOM
(84)
SMV
(391)
WAT
(455)
FRY
(433)
RUS
(485)
NHH
(242)
ENH
(443)
NCR
(367)
SHC
(379)
IPS
(436)
NPH
(245)
RAD
(526)
BAT(376)
(489)
PMS
LER
(768)
STO
(595)
BAR
(250)
RDE
(522)
IOW
(250)
BLA
(463)
DID
(371)
BRI
(345)
STD
(208)
NEV
(254)
WHC
(301)
MAY
(274)
WAR
(295)
MPH
(368)
RCH
(639)
SDG
(230)
NWG
(83)
RSC
(429)
GHS
(365)
YDH
(368)
WRG
(503)
WIR
(462)
SGH
(569)
WRX
(266)
SHH
(332)
SCA
(294)
WDH
(256)
HCH
(285)
LON
(140)
ASH
(333)
CHG
(299)
RSU
(330)
WHH(92)
(423)
BRG
ADD
(450)
HIN
(152)
Routine by specialist
nurse (8.3%)
Medical review following
request (2.0%)
No assessment (27.2%)
Unknown (0.5%)
EBH
(482)
AIR
(275)
UHW
(510)
BED
(176)
NGS
(588)
AEI
(316)
WSH
(284)
STH
(191)
COC
(336)
LGH
(285)
KTH(109)
(288)
MKH
HUD
(445)
RVN
(401)
QEB
(414)
SCM
(454)
Hospital (N)
Routine by physician (7.8%)
RFH
(167)
QKL
(323)
JPH(252)
(340)
NUN
BOL
(390)
SUN
(385)
NOB
(85)
GLO
(418)
Routine by geriatrician (48.6%)
PIN(338)
(530)
WEX
PCH
(131)
HOR
(148)
STR
(349)
DRY
(356)
LEW
(202)
GGH
(248)
LGI(318)
(639)
QEG
QEQ
(372)
HAR
(286)
NUH
(381)
NMG
(331)
HIL
(198)
SLF
(223)
BAS(144)
(405)
WHT
TRA(412)
(104)
WRC
OLD
(558)
MRI
(173)
RBE
(449)
ESU
(509)
SPH
(441)
LIN
(293)
RLU
(395)
WHI
(387)
DVH
(336)
FAZ
(380)
SEH
(392)
DAR
(351)
SCU
(242)
NTG
(376)
FRY(228)
(433)
GWY
SMV
(391)
NOR
(735)
NCR
(367)
COL
(520)
NHH(311)
(242)
WMH
RAD
(526)
KCH
(114)
IPS
(436)
YEO
(190)
STO
(595)
PIL
(311)
PMS(352)
(376)
GWE
BLA(489)
(463)
DER
RDE
(522)
NTH
(364)
NEV
(254)
NTY
(308)
BRI(164)
(345)
GEO
MPH
(368)
RLI
(231)
MAY
(274)
WGH
(224)
RSC
(429)
CMI
(283)
SDG
(230)
TUN
(351)
WIR
(462)
TLF
(141)
YDH
(368)
WDG
(284)
SCA
(294)
WYB
(144)
WRX
(266)
CLW
(339)
ASH
(333)
NDD
(260)
HCH
(285)
BRT
(293)
BRG
(92)
ALT
(350)
RSU
(330)
WCI
(131)
QKL
(323)
KGH
(356)
HIN
(152)
RPH
(390)
SUN (385)
NUN
(252)
CGH
(286)
AIR (275)
ALL
GLO
(418)
BED (176)
AEI (316)
LGH (285)
STH (191)
RVN (401)
0%
SCM (454)
DRY (356)
GGH (248)
RCH (639)
CHS(503)
(190)
WRG
FRM
(365)
JPH
(340)
BRD
(350)
EBH
(482)
RGH(85)
(243)
NOB
KMH
(344)
NGS
(588)
Already under care of

geriatrician or physician (5.7%)
DID (371)
PGH
(859)
CHG
(299)
PAH
(372)
RFH
(167)
MAC
(246)
ADD
(450)
FGH
(140)
BOL
(390)
Unknown (0.5%)
IOW (250)
100%
WAR (295)
TGA
(224)
SGH
(569)
QAP
(732)
LON
(140)
PLY
(570)
WDH
(256)
PET
(399)
WHH
(423)
100%
CHS (190)
WYT (291)
Hospital (N)
In the 2012 report we

reminded users that this
standard was designed to
capture review by doctors
of grade ST3 or above.
Since a number of hospitals
have persisted in including
reviews by Foundation
doctors, they have been
excluded from this chart.
The percentage of patients
reviewed routinely by a
geriatrician has risen to
47.1% compared with 24%
in 2009, due in part to the
influence of BPT in England.
In 42 hospitals
fewer than
Already under care of
or physician
(5.7%)
half ofgeriatrician
the patients
receive
Routine
by
geriatrician
(48.6%)
senior assessment prior to
surgery.
Routine by physician (7.8%)
20%
40%
60%
80%
MKH (109)
WEX (338)
100%
HOR (148)
QEG (318)
(286)
Cases are categorised
by the highest level of assessment that they received. The legend shows the levels in hierarchicalHAR
order.
NMG (331)
Cases are categorised by the highest level of assessment that they received. The legend shows the levels in hierarchical order. WHT (144)
SLF (223)
Six hospitals excluded
due
to
misinterpretation
of
the
preoperative
medical
assessment
field.
Six hospitals excluded due to misinterpretation of the preoperative medical assessment field. WRC (412)
MRI (173)
ESU (509)
FAZ (380)
DAR (351)
NOR (735)
LIN (293)
WHI (387)
NTG (376)
GWY (228)
WMH (311)
Copyright National Hip Fracture Database 2013. COL
All (520)
rights reserved.39
YEO (190)
PIL (311)
NTH (364)
KCH (114)
GWE (352)
DER (489)
GEO (164)
Chart 20 Bone health assessment and treatment at discharge

Both bone health and
falls assessments have
continued to make marginal
improvements, with very
few patients receiving no
secondary prevention.
0%
20%
40%
60%
80%
WYT (263/291)
WRG (450/503)
WHH (361/423)
SAL (250/278)
RLU (361/395)
RHC (248/273)
RFH (154/167)
RBE (415/449)
QEG (272/318)
PET (371/399)
MRI (154/173)
LIN (275/293)
IOW (224/250)
DID (343/371)
CRG (205/218)
BSL (145/168)
BRI (305/345)
BAR (227/250)
ADD (423/450)
WES (141/147)
QAP (696/732)
PIL (286/311)
KTH (271/288)
OLD (512/558)
RDE (497/522)
SPH (416/441)
WAT (403/455)
RVN (375/401)
BAS (371/405)
YDH (349/368)
QEQ (334/372)
SHC (329/379)
KMH (310/344)
RSU (297/330)
ASH (297/333)
NTY (282/308)
AEI (281/316)
CHG (276/299)
NUN (225/252)
MAC (223/246)
RUS (440/485)
TGA (201/224)
RCH (594/639)
GLO (371/418)
DGE (342/373)
HRI (497/538)
DER (489/489)
MDW (309/339)
BRO (306/346)
STO (569/595)
PGH (823/859)
HOR (137/148)
WHC (273/301)
BLA (404/463)
AIR (254/275)
GWH (253/269)
SCU (225/242)
RED (224/250)
EBH (448/482)
PAH (336/372)
GWY (215/228)
OHM (309/335)
TOR (403/436)
WMU (198/216)
LEW (184/202)
BFH (364/378)
WAR (267/295)
Continued from preadmission (11.1%)
WSH (266/284)
NGS (523/588)
BRG (87/92)
FAZ (345/380)
ROT (243/275)
NWG (77/83)
SEH (373/392)
BAT (444/489)
Awaits bone clinic

assessment (3.5%)
Assessed no bone
protection medication
needed or appropriate (14.8%)
WMH (275/311)
RSC (409/429)
IPS (404/436)
MPH (332/368)
Hospital (n/N)
Awaits DXA scan (8.0%)
SDG (216/230)
HIN (141/152)
Started on this admission (56.9%)
LDH (262/305)
FRM (321/365)
FGH (128/140)
LON (127/140)
JPH (311/340)
UHN (667/739)
SMV (360/391)
SCM (413/454)
CHS (170/190)
WHI (337/387)
FRY (381/433)
BOL (349/390)
PMS (336/376)
HIL (183/198)
TRA (91/104)
WHT (136/144)
BRT (272/293)
STD (181/208)
PIN (485/530)
NTG (352/376)
NCR (348/367)
DVH (299/336)
RLI (211/231)
UHC (440/486)
ENH (394/443)
STM (275/301)
GEO (150/164)
SUN (331/385)
STH (178/191)
WIR (419/462)
SLF (200/223)
BED (164/176)
LGH (255/285)
GGH (219/248)
SCA (280/294)
QKL (305/323)
Unknown (1.2%)
NMH (120/138)
UHW (451/510)
SAN (304/337)
MAY (242/274)
YEO (176/190)
DRY (317/356)
HAR (266/286)
NOR (677/735)
WWG (290/332)
DAR (308/351)
WEX (306/338)
HCH (256/285)
NUH (355/381)
STR (306/349)
BNT (284/305)
NPH (221/245)
COC (300/336)
HOM (79/84)
WYB (128/144)
PLY (533/570)
QEB (380/414)
ESU (460/509)
CGH (261/286)
WGH (212/224)
NHH (219/242)
SHH (288/332)
KGH (325/356)
GHS (325/365)
TUN (323/351)
MKH (94/109)
LGI (574/639)
SGH (516/569)
LER (713/768)
NTH (315/364)
CLW (297/339)
RAD (490/526)
KCH (103/114)
RPH (354/390)
COL (483/520)
RSS (303/325)
WDG (266/284)
VIC (388/414)
GWE (307/352)
MOR (463/534)
CHE (323/347)
NEV (215/254)
NDD (234/260)
RVB (837/896)
BRD (299/350)
WRC (376/412)
RGH (211/243)
HUD (401/445)
CMI (271/283)
TLF (134/141)
NMG (293/331)
NOB (80/85)
POW (213/240)
WDH (240/256)
WRX (236/266)
WCI (117/131)
ALT (332/350)
PCH (110/131)
SOU (251/270)
ALL
0%
100%
20%
40%
60%
80%
100%
Excludes cases who died in hospital. Cases are categorised by the highest level of bone health assessment that they received.
Excludes cases who died in hospital. Cases are categorised by the highest level of bonee health assessment that they received.
The legend
shows the levels in hierarchical order.
The legend shows the levels in hierarchical order
40

Chart 21 Specialist falls assessment (Blue Book Standard 6)

0%
20%
40%
60%
80%
WRC (376/412)
BRI (305/345)
WYT (263/291)
WRG (450/503)
WMH (275/311)
WHH (361/423)
WES (141/147)
WDG (266/284)
WAR (267/295)
UHC (440/486)
STM (275/301)
STD (181/208)
SCU (225/242)
SCM (413/454)
SAL (250/278)
ROT (243/275)
RLU (361/395)
RHC (248/273)
RBE (415/449)
QEQ (334/372)
QEG (272/318)
QAP (696/732)
PIN (485/530)
PGH (823/859)
PAH (336/372)
NUN (225/252)
NDD (234/260)
LIN (275/293)
FRM (321/365)
FAZ (345/380)
DID (343/371)
CRG (205/218)
CHS (170/190)
BSL (145/168)
BLA (404/463)
BFH (364/378)
BAR (227/250)
OLD (512/558)
RDE (497/522)
RUS (440/485)
ADD (423/450)
SPH (416/441)
IPS (404/436)
RVN (375/401)
PET (371/399)
BAS (371/405)
YDH (349/368)
SHC (329/379)
ASH (297/333)
RSU (297/330)
PIL (286/311)
BNT (284/305)
NTY (282/308)
CHG (276/299)
GWH (253/269)
HRI (497/538)
MAC (223/246)
RLI (211/231)
WAT (403/455)
RCH (594/639)
QEB (380/414)
LEW (184/202)
STH (178/191)
NTG (352/376)
MDW (309/339)
MRI (154/173)
ESU (460/509)
HOR (137/148)
LDH (262/305)
FGH (128/140)
LON (127/140)
FRY (381/433)
AIR (254/275)
SEH (373/392)
UHW (451/510)
SUN (331/385)
JPH (311/340)
Yes awaits falls

clinic assessment (3.0%)
Yes further intervention
not appropriate (4.9%)
No falls assessment (5.4%)
BRO (306/346)
TGA (201/224)
AEI (281/316)
GLO (371/418)
Hospital (n/N)
Yes performed on
this admission (85.4%)
WHC (273/301)
TRA (91/104)
WSH (266/284)
PMS (336/376)
KGH (325/356)
MAY (242/274)
HOM (79/84)
NGS (523/588)
RED (224/250)
BAT (444/489)
WHT (136/144)
TOR (403/436)
UHN (667/739)
WMU (198/216)
DER (489/489)
NMH (120/138)
MPH (332/368)
KTH (271/288)
GWY (215/228)
OHM (309/335)
GEO (150/164)
ENH (394/443)
Unknown (1.2%)
DGE (342/373)
WDH (240/256)
RSC (409/429)
SMV (360/391)
STO (569/595)
DVH (299/336)
LGH (255/285)
NOB (80/85)
DRY (317/356)
RFH (154/167)
NWG (77/83)
SAN (304/337)
RVB (837/896)
SOU (251/270)
KMH (310/344)
KCH (103/114)
COC (300/336)
HAR (266/286)
SCA (280/294)
DAR (308/351)
WRX (236/266)
LER (713/768)
SDG (216/230)
WIR (419/462)
GGH (219/248)
NOR (677/735)
STR (306/349)
QKL (305/323)
CGH (261/286)
CHE (323/347)
HCH (256/285)
SHH (288/332)
WEX (306/338)
NPH (221/245)
GHS (325/365)
VIC (388/414)
HIL (183/198)
BED (164/176)
SLF (200/223)
WHI (337/387)
BRT (272/293)
SGH (516/569)
IOW (224/250)
LGI (574/639)
EBH (448/482)
NCR (348/367)
RAD (490/526)
RPH (354/390)
COL (483/520)
NHH (219/242)
BOL (349/390)
RSS (303/325)
PLY (533/570)
MOR (463/534)
GWE (307/352)
WGH (212/224)
BRD (299/350)
WYB (128/144)
WWG (290/332)
YEO (176/190)
NEV (215/254)
NTH (315/364)
NUH (355/381)
MKH (94/109)
TLF (134/141)
RGH (211/243)
TUN (323/351)
NMG (293/331)
HIN (141/152)
CMI (271/283)
POW (213/240)
BRG (87/92)
HUD (401/445)
WCI (117/131)
PCH (110/131)
CLW (297/339)
ALT (332/350)
ALL
0%
100%
20%
40%
60%
80%
100%
Excludes
cases
who
in hospital.
Excludes cases
who
died died
in hospital.
Chart 22 Length of acute and post-acute Trust stay

0
5
10
15
20
25
30
(NHFD data)
Mean length of acute stay

(Mean over all cases = 15.7 days)
Mean length of post acute stay
(Mean over all cases = 4.3 days)
Hospital (n/N)
The mean combined length

of acute and post-acute
hospital stay has fallen
further to less than 20 days.
STO (579/595)
WDH (252/256)
TOR (389/436)
HCH (269/285)
SCU (233/242)
RDE (507/522)
PGH (702/859)
PLY (538/570)
DER (457/489)
RAD (486/526)
QKL (311/323)
RCH (611/639)
CMI (264/283)
SEH (377/392)
STR (329/349)
MPH (354/368)
GGH (234/248)
BFH (325/378)
LER (646/768)
CHG (270/299)
COL (488/520)
BRD (331/350)
NOB (43/85)
BAT (461/489)
KTH (279/288)
MDW (313/339)
PIL (289/311)
GLO (393/418)
WHT (134/144)
BSL (161/168)
WAT (404/455)
YEO (169/190)
IOW (238/250)
SCM (429/454)
SCA (276/294)
NOR (694/735)
RED (230/250)
WRC (390/412)
QAP (682/732)
SOU (261/270)
ADD (426/450)
IPS (414/436)
LEW (186/202)
AEI (293/316)
BAR (242/250)
RBE (418/449)
PET (398/399)
RFH (142/167)
UHN (700/739)
CHS (180/190)
QEG (302/318)
HRI (509/538)
TGA (215/224)
WCI (131/131)
SLF (206/223)
YDH (363/368)
PAH (348/372)
SGH (519/569)
DGE (342/373)
WMH (294/311)
JPH (306/340)
CGH (271/286)
BNT (261/305)
STM (284/301)
NCR (340/367)
WHC (269/301)
RUS (449/485)
AIR (265/275)
RLU (362/395)
LIN (280/293)
NMH (124/138)
BOL (367/390)
WEX (309/338)
PIN (503/530)
LDH (274/305)
PMS (347/376)
STH (174/191)
LGH (279/285)
WRG (480/503)
BRT (264/293)
FRM (342/365)
BAS (377/405)
HOR (139/148)
WHH (386/423)
DID (355/371)
ENH (418/443)
TLF (138/141)
RSC (425/429)
RVB (811/896)
OHM (299/335)
WSH (272/284)
HAR (261/286)
NUH (355/381)
NPH (169/245)
NHH (221/242)
WMU (204/216)
ALT (287/350)
CHE (332/347)
HIL (179/198)
SHC (375/379)
DVH (298/336)
KGH (325/356)
SAL (249/278)
BRG (71/92)
GHS (358/365)
NTG (349/376)
ROT (262/275)
CRG (166/218)
NWG (54/83)
LGI (590/639)
QEQ (346/372)
SUN (350/385)
GWH (203/269)
SDG (207/230)
RSU (305/330)
RSS (307/325)
SPH (406/441)
NUN (201/252)
BLA (428/463)
WGH (205/224)
DAR (329/351)
HIN (129/152)
NMG (313/331)
SMV (327/391)
VIC (388/414)
NGS (554/588)
TUN (341/351)
ESU (462/509)
SHH (310/332)
RHC (253/273)
NTY (283/308)
BRO (282/346)
RPH (350/390)
WDG (254/284)
WIR (412/462)
UHC (445/486)
BED (162/176)
NDD (228/260)
FRY (362/433)
HUD (412/445)
WES (107/147)
FGH (120/140)
MAY (244/274)
DRY (334/356)
RLI (231/231)
FAZ (351/380)
NTH (324/364)
WHI (377/387)
OLD (515/558)
QEB (360/414)
WAR (249/295)
GEO (151/164)
EBH (442/482)
MKH (96/109)
MAC (227/246)
SAN (305/337)
KMH (309/344)
POW (215/240)
BRI (292/345)
HOM (72/84)
WYB (135/144)
WYT (244/291)
TRA (90/104)
MRI (150/173)
RVN (361/401)
ASH (295/333)
WRX (229/266)
LON (122/140)
STD (181/208)
KCH (62/114)
PCH (107/131)
COC (276/336)
GWY (169/228)
NEV (194/254)
CLW (292/339)
GWE (300/352)
MOR (418/534)
RGH (209/243)
UHW (381/510)
35
40
35
40
ALL
10
15
20
25
30
Length of stay (days)
Excludes
patients discharged
after 31/3/2013.
Patients with
or implausible
length of stay
are excluded.
and WRGCHS,
have no
dedicated
orthopaedic
ward.
Excludes patients
discharged
after 31/3/2013.
Patients
withunknown
unknown
or implausible
length
of stayCHS,
are STR
excluded.
STR
and WRG
have no
dedicated
For these
acute stay
measured
Trust stay.
WWG is excluded
because
length
stay data
data isis
missing
for 93%
patients.
orthopaedic ward. For these hospitals acute
stay hospitals
is measured
by isTrust
stay.byWWG
is excluded
because
length
ofofstay
missing
forof93%
of patients.
42

Chart 23 Superspell (Third party data sources)

This chart is composed of
data from HES (England),
PEDW (Wales) and FORD
(Northern Ireland). Data are
for the period 1 April 2011
to 31 March 2012.
Mean length of post acute stay

(Mean over all cases from
England = 4.0 days; mean
over all cases from
Northern Ireland = 11.8 days)
Mean length of hospital stay

Wales = 18.3 days)
Mean length of rehab stay
over all cases from
Northern Ireland = 9.0 days;
mean over all cases from
Wales = 16.8 days)
Hospital (N)
Mean length of acute stay

over all cases from
Northern Ireland = 12.5 days)
SCU (258)
COL (539)
GGH (288)
STM (236)
BED (245)
AIR (272)
RFH (187)
QEQ (448)
PGH (879)
BSL (164)
IPS (409)
BRD (279)
BFH (421)
SEH (431)
KTH (352)
SOU (306)
WHH (435)
SLF (215)
RAD (549)
STH (201)
WSH (316)
BNT (279)
WHC (300)
NMH (133)
LEW (169)
WAT (445)
WHT (146)
WEX (399)
ADD (417)
RBE (485)
WES (137)
TOR (452)
TGA (249)
PAH (305)
LGH (334)
STR (404)
CMI (242)
PET (384)
PIL (355)
NPH (320)
WDG (379)
QKL (352)
PIN (513)
LIN (352)
BOL (348)
WMU (207)
DGE (389)
MKH (213)
IOW (226)
DVH (327)
AEI (317)
NUN (234)
HRI (616)
HAR (236)
SGH (593)
NHH (276)
BAT (505)
CGH (312)
SCA (275)
HOR (184)
ESU (440)
CHS (203)
WMH (307)
WGH (291)
QAP (704)
NTG (401)
SDG (277)
GEO (248)
RHC (175)
LDH (272)
LGI (674)
BLA (472)
YEO (217)
HUD (461)
QEG (287)
HIL (246)
RPH (457)
OHM (263)
NDD (227)
JPH (351)
RUS (438)
WCI (168)
WRG (455)
SHC (428)
MDW (351)
WHI (411)
RSC (481)
LER (807)
RSS (329)
RCH (565)
DID (400)
SAL (250)
FAZ (393)
WRC (428)
SUN (405)
ROT (281)
NOR (803)
BRO (400)
NUH (333)
RDE (538)
HOM (101)
WIR (442)
DER (537)
GLO (397)
FRM (331)
WDH (274)
STO (560)
RSU (369)
GHS (392)
FRY (414)
NTY (315)
CHG (330)
MAY (252)
SHH (374)
SCM (458)
COC (330)
PLY (487)
MPH (399)
MAC (272)
GWH (334)
RLU (394)
HIN (211)
RED (260)
VIC (492)
RLI (275)
BAS (379)
UHN (724)
SAN (399)
SMV (379)
PMS (444)
BAR (273)
BRI (339)
LON (164)
NMG (211)
BRT (266)
ASH (320)
TLF (208)
SPH (395)
NGS (583)
OLD (576)
KCH (184)
WYT (304)
HCH (264)
WYB (182)
KGH (344)
STD (227)
NCR (406)
YDH (428)
TRA (127)
NWG (123)
MRI (180)
FGH (148)
UHC (503)
NTH (357)
KMH (368)
WWG (316)
GWY (305)
EBH (473)
CLW (363)
BRG (99)
WAR (293)
CRG (181)
UHW (408)
RVN (418)
CHE (390)
QEB (399)
WRX (289)
RVB (823)
GWE (389)
PCH (217)
NEV (292)
POW (285)
ALT (357)
RGH (178)
MOR (481)
10
15
20
25
30
35
40
45
50
10
15
20
25
30
35
40
45
50
England
Northern Ireland
Wales
Length of stay (days)

For England and Northern Ireland acute stay and post acute stay are measured separately.
For Wales only
stay
(acute
stayacute
andstay
post
staystay
combined)
is measured.
Forhospital
England and
Northern
Ireland
andacute
post acute
are measured
separately.
For Wales only hospital stay (acute stay and post acute stay combined) is measured.
Chart 24 Discharge destination from Trust

These remain largely
unchanged since 2012
0%
20%
40%
60%
80%
WMU (204/216)
HOM (74/84)
SAL (254/278)
GWE (301/352)
WAR (262/295)
OLD (515/558)
SAN (310/337)
MOR (426/534)
KMH (309/344)
HIL (189/198)
POW (237/240)
GWY (169/228)
UHC (446/486)
QEQ (348/372)
QAP (685/732)
FAZ (356/380)
STH (177/191)
BFH (329/378)
WYT (270/291)
KCH (100/114)
MAY (249/274)
HAR (265/286)
HOR (140/148)
STM (284/301)
VIC (388/414)
RVN (361/401)
RGH (209/243)
DRY (335/356)
HRI (513/538)
WYB (138/144)
NWG (64/83)
GWH (238/269)
PET (398/399)
LON (123/140)
WHH (390/423)
OHM (299/335)
NDD (230/260)
UHW (443/510)
WSH (272/284)
PIL (291/311)
FRY (386/433)
LGI (597/639)
PCH (110/131)
CLW (304/339)
NUN (242/252)
BRI (328/345)
NMH (129/138)
TRA (92/104)
CRG (168/218)
SMV (366/391)
STD (185/208)
NPH (230/245)
WIR (421/462)
ADD (434/450)
BED (164/176)
EBH (466/482)
WES (132/147)
BRO (322/346)
QEG (304/318)
RHC (255/273)
DGE (342/373)
ASH (299/333)
SDG (215/230)
NOB (43/85)
MKH (96/109)
HIN (130/152)
NEV (198/254)
RLI (231/231)
COL (488/520)
Nursing care (10.1%)

Dead (9.1%)
Other (2.0%)
Unknown (1.1%)
FGH (123/140)
WWG (25/332)
SCU (233/242)
NTG (349/376)
TLF (138/141)
SPH (410/441)
AIR (273/275)
FRM (346/365)
Hospital (n/N)
Residential care (10.8%)
NHH (222/242)
PAH (349/372)
Rehabilitation unit (19.6%)

Acute hospital (1.0%)
WHT (137/144)
WRX (236/266)
Own home/sheltered
housing (46.4%)
WHI (387/387)
IPS (415/436)
KGH (328/356)
DID (355/371)
SHC (379/379)
RBE (420/449)
QEB (380/414)
SUN (362/385)
BLA (430/463)
NMG (316/331)
YDH (363/368)
PMS (349/376)
BRG (86/92)
WGH (220/224)
CHE (334/347)
BOL (368/390)
TUN (351/351)
NTH (329/364)
JPH (314/340)
WRG (480/503)
NOR (697/735)
NGS (580/588)
WEX (315/338)
KTH (279/288)
LEW (186/202)
SGH (522/569)
COC (303/336)
HUD (415/445)
NUH (357/381)
BAS (385/405)
MRI (159/173)
WDG (254/284)
GHS (361/365)
RFH (163/167)
MAC (227/246)
YEO (180/190)
WDH (252/256)
DVH (310/336)
DAR (332/351)
RLU (367/395)
RUS (460/485)
ENH (418/443)
RSU (330/330)
SOU (268/270)
CGH (273/286)
CMI (264/283)
NTY (284/308)
RED (232/250)
UHN (701/739)
PGH (832/859)
LIN (281/293)
GEO (159/164)
QKL (314/323)
BRT (264/293)
SHH (311/332)
BNT (284/305)
ALT (287/350)
GLO (398/418)
NCR (351/367)
RSC (429/429)
GGH (240/248)
MDW (322/339)
CHG (274/299)
SCM (429/454)
WMH (299/311)
RDE (510/522)
RCH (612/639)
BSL (161/168)
LER (656/768)
WRC (404/412)
LGH (285/285)
ROT (262/275)
TGA (217/224)
STR (329/349)
WHC (272/301)
PIN (505/530)
CHS (180/190)
WCI (131/131)
LDH (285/305)
RVB (814/896)
BRD (338/350)
SCA (279/294)
SEH (381/392)
IOW (240/250)
MPH (354/368)
WAT (434/455)
ESU (468/509)
RAD (495/526)
RSS (308/325)
STO (580/595)
AEI (298/316)
BAT (464/489)
SLF (209/223)
RPH (353/390)
TOR (423/436)
HCH (275/285)
BAR (242/250)
PLY (546/570)
DER (460/489)
ALL
0%
100%
20%
40%
60%
80%
100%
Excludes patients discharged after 31/3/2013.

Excludes patients discharged after 31/3/2013.
44

Chart 25 Re-operation within 30 days

0%
It is difficult to comment on
the reoperation data, other
than to note how poorly it
is recorded.
20%
40%
60%
80%
PAH (338/372)
BAS (371/405)
NEV (181/254)
WAR (258/295)
NWG (59/83)
RLU (360/395)
MKH (94/109)
PMS (345/376)
BRI (318/345)
CHG (271/299)
WIR (410/462)
SEH (376/392)
NCR (345/367)
CHS (177/190)
MRI (152/173)
NTH (320/364)
MOR (410/534)
ENH (410/443)
CLW (287/339)
MAY (247/274)
RSS (252/325)
NOB (42/85)
SOU (260/270)
NMG (306/331)
HUD (396/445)
STD (177/208)
WHC (267/301)
GHS (358/365)
WHT (135/144)
DER (452/489)
BAT (453/489)
STM (278/301)
FRY (384/433)
GWE (294/352)
RHC (246/273)
SPH (405/441)
WSH (271/284)
PGH (825/859)
AEI (285/316)
GGH (229/248)
YDH (345/368)
STH (173/191)
ASH (291/333)
SUN (351/385)
LEW (177/202)
FGH (119/140)
BOL (359/390)
UHW (433/510)
UHC (434/486)
RDE (506/522)
FRM (326/365)
GLO (393/418)
LIN (270/293)
TUN (344/351)
PIN (494/530)
QAP (679/732)
NUN (238/252)
BRD (319/350)
BED (163/176)
DRY (329/356)
WDG (252/284)
DGE (338/373)
BLA (424/463)
HCH (263/285)
MPH (352/368)
TRA (89/104)
RUS (447/485)
KTH (273/288)
WRC (386/412)
SDG (204/230)
NHH (207/242)
TOR (415/436)
RSC (423/429)
NDD (222/260)
WRX (225/266)
EBH (456/482)
POW (229/240)
QEQ (344/372)
GWH (234/269)
ROT (247/275)
No reoperation
within 30 days (42.4%)
Unknown (56.6%)
Hospital (n/N)
NMH (128/138)
Reoperation
within 30 days (1.0%)
WHH (387/423)
WES (129/147)
CMI (259/283)
HAR (261/286)
RBE (410/449)
NTY (276/308)
BNT (280/305)
ADD (432/450)
PIL (289/311)
LGI (578/639)
COC (289/336)
QEG (291/318)
SAN (301/337)
KMH (306/344)
GEO (156/164)
STR (314/349)
DAR (320/351)
BFH (320/378)
RVB (804/896)
GWY (168/228)
RVN (350/401)
SMV (358/391)
STO (567/595)
MAC (221/246)
RED (230/250)
IOW (231/250)
RAD (467/526)
SAL (251/278)
OLD (514/558)
PLY (535/570)
LGH (270/285)
ALT (273/350)
OHM (294/335)
DVH (294/336)
JPH (308/340)
MDW (310/339)
RSU (323/330)
KGH (327/356)
NUH (345/381)
UHN (693/739)
QEB (372/414)
IPS (406/436)
COL (473/520)
NGS (566/588)
RCH (599/639)
YEO (174/190)
WYT (263/291)
WYB (128/144)
WWG (25/332)
WRG (475/503)
WMU (193/216)
WMH (288/311)
WHI (387/387)
WGH (217/224)
WEX (308/338)
WDH (242/256)
WCI (125/131)
WAT (429/455)
VIC (388/414)
TLF (127/141)
TGA (206/224)
SLF (206/223)
SHH (304/332)
SHC (368/379)
SGH (512/569)
SCU (224/242)
SCM (408/454)
SCA (275/294)
RPH (248/390)
RLI (230/231)
RGH (202/243)
RFH (157/167)
QKL (313/323)
PET (392/399)
PCH (104/131)
NTG (344/376)
NPH (218/245)
NOR (683/735)
LON (122/140)
LER (629/768)
LDH (280/305)
KCH (99/114)
HRI (505/538)
HOR (136/148)
HOM (71/84)
HIN (129/152)
HIL (188/198)
FAZ (346/380)
ESU (459/509)
DID (343/371)
CRG (160/218)
CHE (330/347)
CGH (270/286)
BSL (151/168)
BRT (256/293)
BRO (310/346)
BRG (84/92)
BAR (235/250)
AIR (269/275)
ALL
0%
100%
20%
40%
60%
80%
100%
Excludes patients
who
did who
not did
receive
surgery
ororwere
discharged
31/3/2013.
Excludes
patients
not receive
surgery
were discharged
afterafter
31/03/2013.
Chart 26 Follow up data completeness at 30 days

There has been a marginal
improvement in 30 day
follow up data but no
change in 120 follow up
data.
0%
20%
40%
60%
80%
RVB
NUH
YDH
BRI
ALT
PGH
RHC
QAP
CRG
RVN
BLA
GWE
FRM
BRD
PIN
BAS
MDW
NHH
PLY
SOU
WAR
CMI
NEV
UHC
PAH
FRY
SPH
NCR
SDG
LIN
UHW
NDD
WDG
PIL
QEG
RDE
PMS
RBE
NOB
GHS
JPH
AEI
MRI
WHH
MOR
STR
DID
NTH
BSL
WSH
HUD
BOL
GWH
COC
QEQ
SEH
DVH
LON
MKH
ASH
NMG
NTY
SCU
RSS
TRA
FGH
SUN
HOM
CLW
GGH
CHG
WIR
PCH
OHM
NWG
NUN
WRC
TOR
OLD
HCH
SMV
NTG
KMH
WHC
Not complete (62.8%)
Hospital
WRG
Complete (37.2%)
MAC
GWY
EBH
RLU
ROT
LGI
GLO
TUN
HAR
SAN
STH
WRX
POW
NMH
ENH
BAT
WAT
MPH
QEB
WES
BRG
STD
SCM
TGA
DGE
IPS
RCH
YEO
WHT
BED
COL
BNT
HIL
KGH
CHS
ADD
IOW
WYT
PET
NGS
GEO
WEX
CGH
WDH
NOR
FAZ
RGH
LDH
WMH
KTH
WYB
WWG
WMU
WHI
WGH
WCI
VIC
UHN
TLF
STO
STM
SLF
SHH
SHC
SGH
SCA
SAL
RUS
RSU
RSC
RPH
RLI
RFH
RED
RAD
QKL
NPH
MAY
LGH
LEW
LER
KCH
HRI
HOR
HIN
ESU
DRY
DER
DAR
CHE
BRT
BRO
BFH
BAR
AIR
ALL
0%
100%
20%
40%
60%
80%
100%
Completeness of six fields about patient condition 30 days after admission for patients not recorded to be dead at 30 days.
46

Chart 27 Follow up data completeness at 120 days

0%
20%
40%
60%
80%
RVB
NUH
CRG
RDE
BRI
QAP
QEG
PGH
STH
FRM
BRD
AEI
RHC
NEV
NOB
WAR
MDW
BAS
ALT
NDD
NTH
BLA
DID
MRI
PLY
UHC
BSL
NHH
GWE
SDG
WSH
JPH
SOU
WDG
NCR
PIL
PMS
DVH
LIN
STR
RBE
SCU
NTG
PAH
YDH
CHG
GLO
BOL
GWH
GGH
PIN
CLW
MOR
SMV
FRY
WHH
SUN
HOM
OHM
COC
ROT
FGH
SEH
PCH
QEQ
LON
RSS
RLU
TRA
POW
NMG
WRX
MKH
OLD
GWY
KMH
NWG
RVN
CHS
TOR
TGA
NMH
WRG
CMI
Not complete (73.7%)
Hospital
QEB
Complete (26.3%)
HUD
WIR
STD
MAC
YEO
NUN
MPH
BAT
IPS
WES
HAR
RCH
GHS
CGH
KGH
WHC
EBH
ASH
BAR
WEX
PET
WYT
WYB
WWG
WRC
WMU
WMH
WHT
WHI
WGH
WDH
WCI
WAT
VIC
UHW
UHN
TUN
TLF
STO
STM
SPH
SLF
SHH
SHC
SGH
SCM
SCA
SAN
SAL
RUS
RSU
RSC
RPH
RLI
RGH
RFH
RED
RAD
QKL
NTY
NPH
NOR
NGS
MAY
LGI
LGH
LEW
LER
LDH
KTH
KCH
IOW
HRI
HOR
HIN
HIL
HCH
GEO
FAZ
ESU
ENH
DRY
DGE
DER
DAR
COL
CHE
BRT
BRO
BRG
BNT
BFH
BED
AIR
ADD
ALL
0%
100%
20%
40%
60%
80%
100%
Casemix adjusted outcomes

Chart 28 Return home from home at 30 days for 2012 to
2013
Cases were eligible for the return home from home analysis if they were admitted from their own
home between 1 March 2012 and 28 February 2013 inclusive. This time period is a month earlier than
that of the remainder of the report to allow for 30 day follow-up.
There were 46,093 eligible cases but residential status at 30 days was missing for 55.2% of these
cases. Cases with missing residential status were excluded, and so the return home from home data set
includes 20,634 cases.
The classification tree for this analysis is shown in Appendix D. The most important predictors of return
home from home at 30 days are whether accompanied to walk outdoors, age and ASA grade. The tree
was used to calculate standardised 30 day return home from home rates displayed in this funnel plot.
Hospitals were excluded from the funnel plot if fewer than 60 cases were available for the return home
from home analysis (Appendix D).
48

The overall rate of return home from home at 30 days for all cases included in the analysis is 46.2%.
Many hospitals lie outside of the 95% and 99.8% tolerance intervals, but caution is necessary when
drawing conclusions about these hospitals. This over-dispersion is a common feature of provider
comparison analyses. It may arise because hospitals differ in their policies regarding return home from
home or because of the high proportion of missing data.
There are seven hospitals with standardised rates of return home from home at 30 days below the
99.8% tolerance intervals.
The unit with the lowest standardised rate (4.7%) was EBH with 40.6% (compared to a national
average of 12.8%) of those admitted from home still being in the acute hospital, and a further
39.8% (compared to 21.7%) still in a rehabilitation unit at 30 days. This hospital also had the lowest
standardised rate of return home from home at 30 days in 201112 (4.9%), and the second lowest rate
in 201011 (11.7%).
The six other hospitals where the standardised return home from home rates are below the 99.8%
tolerance interval are RSS, ENH, ROT, NUN, MOR and PLY. Three of these (RSS, NUN and PLY) also had
return home from home rates below the 99.8% limit in the 201112 analysis.
There are fifteen hospitals with particularly good return home from home rates at 30 days adjusted
return home from home rates are above the 99.8% tolerance interval. The two most impressive are
WSH and GWH, each with standardised rates of return home of approximately 70%. Eight of these
(FRM, FRY, GWH, PAH, QAP, QEG, RHC and WSH), had performed similarly well in the 201112 analysis.
Four hospitals (BAS, CMI, SMV and STH) had return home from home rates between the upper 95%
and 99.8% tolerance intervals in the 20112012 analysis.
Chart 29 Funnel plot for mortality at 30 days

The overall rate of mortality at 30 days is 8.2% across all cases included in this years analysis.
The classification tree was used to calculate standardised 30 day mortality rates.
The most important predictors of mortality at 30 days are ASA grade, whether accompanied to walk
outdoors, age and gender. These case mix factors were also the most important predictors of mortality
at 30 days for 201112. A number of hospitals that were identified as being potential outliers on an
initial analysis were given the opportunity to address issues of missing data (particularly in respect of ASA
grade), and missing cases as described in Appendix F.
The final data submitted after this review was used to recalculate raw and standardised rates, which are
displayed in a funnel plot (Chart 29).
Hospitals with unusually high or low standardised 30 day mortality rates are identified in the funnel plot
as having an alert or alarm status, indicating the level of concern regarding the units performance. No
units have standardised mortality rate outside the 99.8% tolerance interval, e.g. no units have an alarm
status.
However five hospitals (FRY, LDH, STR, WAT and WHH) have standardised mortality rates statistically
higher than would be expected, and lie outside the 95% tolerance interval an alert. In one further
case, review of the data suggests that the outlying position may reflect poor quality of the units c asemix data, as their unadjusted rate was well within normal expectations. This illustrates the fact that a
hospital may be a statistical outlier due to inaccurate data collection or data entry. Additionally, case-mix
adjustment may fail to recognise some factor that places an individual at greater risk of dying, and the
use of statistical analysis inevitably carries a small risk that a unit may be outside the funnel by chance.
Chart 29 : Funnel plot for 30 day mortality based on 201213 data

50

Chart 30 Funnel plot for mortality at 30 days for

3 consecutive years
To test the robustness of this years analysis we used data collected over the past three years (201013)
to examine trends in performance for the outliers identified in this years report.
The overall rate of mortality at 30 days in this larger dataset is 8.4%. A higher number of cases supports
tighter tolerance intervals so the three year funnel plot will identify more outliers. A number of hospitals
showed standardised mortality rates outside the 95% tolerance interval. However, since these units
were not outliers in this years data they are not considered further in this annual report. These units are
aware of their potential outlier status and have been requested to undertake the same datachecks that
the outlying units for 201213 have made. Next years report will include a unit identifiable three year
funnel plot.
The current three year data was used to review performance for the five outliers (FRY, LDH, STR, WAT
and WHH) which fell outside the 95% tolerance limit of this years funnel plot (Chart 29).
FRY and WHH were not outliers when data collected over the three year period 201013 was
considered
STR was identified as an outlier in the 201011 report and this years reports, and remained an
outlier in this three year analysis
Chart 30 : Funnel plot for 30 day mortality based on 201013 data

In contrast, two units (LDH and WAT) triggered concerns on 201213 data, and these hospitals were
confirmed as outliers when the three years data were analysed.
Over the 201013 period both LDH and WAT lay outside the 95% and the 99.8% thresholds for 30 day
mortality (Chart 30).
52

Chart 31 Trend analysis

A group of 27 hospitals with longer term NHFD participation, and sustained high levels of casereporting and data completeness have been monitored over a number of years
Trends in five care quality indicators have been tracked and show year-on-year improvements which,
with the exception of mortality, are highly statistically significant.
This analysis is described in detail in Appendix G, and confirms the value of continuous audit in
improving both process and outcome.
Trends in care, secondary prevention and mortality: April 2008 to March 2013
Best Practice Tariff (BPT)

The NHFD with its extensive coverage and detailed documentation of casemix, care and outcomes
prompted the selection of hip fracture as a topic for the Department of Healths BPT initiative, which
applies only in England. BPT offers additional payment for cases the care of which meets agreed
standards (surgery within 36 hours; shared care by surgeon and geriatrician; care protocol agreed by
geriatrician, surgeon and anaesthetist; pre/post operative cognitive function assessment; perioperative
assessment by geriatrician; geriatrician-led multi-disciplinary rehabilitation; secondary prevention
including falls and bone health assessment) that are monitored by the NHFD.
As the table and bar-chart below show, between April 2010 and April 2013 participation has increased
steadily quarter by quarter, with the exception of Quarter 1 & Quarter 2 2012/13 possibly due to the
introduction of AMT scores as part of BPT.
Chart 33 has been coloured in a way that demonstrates better how individual hospitals are falling short
of Best Practice.
Eligible
hospitals
Hospitals
achieving
BPT
Number
of pts
submitted
Number of
pts achieving
BPT
Qtr 1
162
92 (57%)
9455
2303 (24%)
2 81%
Qtr 2
165
105 (64%)
11839
3328 (28%)
2 74%
Qtr 3
163
111 (68%)
13136
4502 (34%)
1 83%
Qtr 4
167
118 (71%)
12680
4671 (37%)
1 86%
Qtr 1
170
131 (77%)
13070
5210 (40%)
1 88%
Qtr 2
166
133 (80%)
13221
6170 (47%)
1 89%
Qtr 3
166
138 (82%)
14116
7193 (51%)
2 88%
Qtr 4
168
147 (87%)
14046
7654 (55%)
2 95%
Qtr 1
166
149 (90%)
13998
6833 (49%)
3 93%
Qtr 2
166
150 (91%)
13753
7168 (52%)
4 95%
Qtr 3
166
154 (93%)
14158
8373 (59%)
14 97%
Qtr 4
166
156 (94%)
14317
8553 (60%)
5 95%
2010/11
Range
2011/12
2012/13
54
Chart 32 Quarter by quarter BPT criteria compliance and BPT achievement: 20102013
120
100
80
60
40
20
0

% to theatre % joint care
% joint
%
% MDT
% falls
% bone
<36 hrs protocol
geriatrician
rehab
assessment
health
<72 hrs
assessment
55
10/11 Q1
11/12 Q1
12/13 Q1
10/11 Q2
11/12 Q2
12/13 Q2
10/11 Q3
11/12 Q3
12/13 Q3
10/11 Q4
11/12 Q4
12/13 Q4
AMTS 1
AMTS 2
% BPT
Chart 33 BPT achievement (England only)

0%
20%
40%
60%
80%
SHC (379)
PIL (291)
ASH (299)
NTY (284)
HOR (140)
WSH (272)
SAL (254)
RHC (255)
RUS (460)
QAP (685)
SPH (410)
WRG (480)
BAT (464)
DGE (342)
NMH (129)
PMS (349)
FRY (386)
CHS (180)
RSU (330)
RDE (510)
NGS (580)
ENH (418)
RBE (420)
AIR (273)
SCA (279)
FAZ (356)
WAT (434)
SUN (362)
UHN (701)
NTG (349)
RLU (367)
BLA (430)
DER (460)
WHH (390)
NCR (351)
GLO (398)
WAR (262)
ROT (262)
RVN (361)
PGH (832)
PAH (349)
HIL (189)
BFH (329)
RCH (612)
BNT (284)
LEW (186)
QEQ (348)
LDH (285)
BAR (242)
KTH (279)
RSC (429)
ESU (468)
Eligible met
all 9 criteria (60.1%)
KMH (309)
Ineligible met
8 criteria (25.8%)
SGH (522)
WHC (272)
WES (132)
UHC (446)
SCM (429)
QEG (304)
IPS (415)
NHH (222)
Ineligible met
1 criteria (0.0%)
NOR (697)
AEI (298)
Ineligible met
5 criteria (2.1%)
STR (329)
BSL (161)
NUN (242)
PIN (505)
STO (580)
Hospital (N)
Ineligible met
2 criteria (0.3%)
LON (123)
SDG (215)
Ineligible met
6 criteria (2.7%)
Ineligible met
3 criteria (1.0%)
FGH (123)
MPH (354)
GWH (238)
Ineligible met
4 criteria (1.4%)
WIR (421)
HAR (265)
Ineligible met
7 criteria (6.6%)
WEX (315)
RED (232)
SEH (381)
BAS (385)
PET (398)
SMV (366)
QEB (380)
SHH (311)
TOR (423)
SAN (310)
MRI (159)
YDH (363)
OLD (515)
MAC (227)
ADD (434)
MDW (322)
BRT (264)
MAY (249)
FRM (346)
HRI (513)
STH (177)
STM (284)
WHT (137)
WMH (299)
HCH (275)
QKL (314)
DID (355)
COC (303)
RAD (495)
TGA (217)
WHI (387)
RFH (163)
LER (656)
JPH (314)
RLI (231)
SLF (209)
NWG (64)
IOW (240)
DRY (335)
BED (164)
SCU (233)
COL (488)
CHE (334)
MKH (96)
EBH (466)
BRO (322)
WGH (220)
DVH (310)
WRC (404)
STD (185)
CGH (273)
WDG (254)
CHG (274)
LGI (597)
GHS (361)
DAR (332)
OHM (299)
YEO (180)
GEO (159)
WMU (204)
GGH (240)
LIN (281)
BRD (338)
HOM (74)
BRI (328)
HIN (130)
LGH (285)
NPH (230)
VIC (388)
TRA (92)
WDH (252)
BOL (368)
PLY (546)
KGH (328)
WYT (270)
CMI (264)
TUN (351)
NTH (329)
NMG (316)
RPH (353)
KCH (100)
WCI (131)
TLF (138)
SOU (268)
RSS (308)
NOB (43)
NDD (230)
HUD (415)
ALL
0%
100%
20%
40%
60%
80%
100%
Only includes hospitals in England. No patient met 0 criteria.

Only includes hospitals in England. No patient met 0 criteria.
56
Best Practice Tariff achievement by region

East Midlands
East of England
London
57
North East
North West
South Central
58
South East Coast
South West
West Midlands
59
Yorkshire & the Humber
60

Facilities audit
Hospitals vary considerably in the way in which they offer treatment to hip fracture patients. In order to
understand those differences better, hospitals are asked to submit data about their staff and facilities.
Facilities Audit Chart 1

Number of orthogeriatric ward rounds each week
8%
5%
4%
1
2
13%
3
4
5
45%
6+
13%
12%
Since orthogeriatric input is an important factor in the development of care in line with Best Practice
Tariff, it is not surprising that daily orthogeriatric ward rounds are increasing in frequency. 53% of
hospitals have five or more ward rounds per week compared with 31.8% in 2011. The percentage of
hospitals having no orthogeriatric ward rounds is down to 5%, from 14.2% in 2011, with the majority
of the hospitals being outside England.

On-site falls clinic
18%
Led by consultant
Led by nurse
No clinic
7%
75%
The percentage of hospitals providing on-site falls clinics has not changed since 2012

On-site DXA scanners
Axial scanners
25%
Peripheral scanners
No scanner
66%
9%
The gradual rise in the provision of on-site scanners continues with the total percentage increasing to
75% compared with 68.2% in 2011.
62


Data collectors
3%
2%
Nurses
12%
Doctors
Audit staff
Admin staff
Care assistant
12%
71%
There has been a marginal increase in the percentage of data collection by nurses, up from 66.5% in
2011 to 71%. In many cases the nurses act as fragility fracture nurses, co-ordinating the care of the hip
fracture patients. They are therefore in a position to collect the data concurrent to the episode of care.
Trends in the staffing of units

Since the introduction of Best Practice Tariff in England in 2010 there has been a significant financial
incentive to provide joint orthopaedic/orthogeriatric care for hip fracture patients. This chart shows a
continuation the rise of orthogeriatric provision.
180%
170%
OG Consultant hrs
160%
OG Middlegrade hrs
150%
140%
OG WR
130%
WTE fragility fracture nurse
120%
WTE FLS nurse
110%
100%
2010 2011 2012 2013
Unsurprisingly, the greatest rise is in the hours of consultant orthogeriatrician time allocated to the
trauma wards, 68% in three years.
Fracture liaison
The secondary prevention of osteoporotic fractures is vitally important, especially since less serious
fractures identified at an earlier stage in the osteoporotic process might trigger interventions to prevent
hip fractures.
An effective means to achieving this is the Fracture Liaison Service, where specially trained staff identify
patients with fragility fractures and assess their treatment requirements.
It is gratifying to see an increase in the time allocated to fracture liaison work, up 12% since 2010.
However, disappointingly 64% of hospitals say that they have no Fracture Liaison Nurse, an indication
that there is still considerable scope for service improvement.
64
Regional summary tables

Mean (SD) total length of stay
acute + post-acute (days)
Mean (SD) length of post-acute stay

(days)
% Bone health medication

assessment (BB Std 5)
347
89.0
90.5
55.3
86.9
0.3
1.9
85.5
100.0
20.2 (14.9)
0.39 (3.3)
20.6 (14.9)
Derbyshire Royal Infirmary, Derby
DER
570
489
85.8
92.3
76.5
96.0
29.2
2.8
61.1
99.0
12.3 (10.2)
0.26 (1.9)
12.6 (10.5)
Kettering General Hospital
KGH
300
356
118.7
85.6
69.0
92.5
5.9
10.4
84.2
100.0
19.6 (16.2)
1.32 (7.4)
20.9 (18.0)
Kings Mill Hospital, Sutton in Ashfield
KMH
360
344
95.6
96.1
85.4
88.9
2.0
0.6
91.0
97.1
16.1 (14.3)
10.48 (17.3)
26.6 (21.4)
LER
900
768
85.3
92.1
36.0
91.8
93.2
5.7
86.2
98.6
13.7 (9.3)
1.09 (4.9)
14.7 (10.0)
Lincoln County Hospital
LIN
390
293
75.1
93.8
67.6
88.6
40.3
0.7
100.0
100.0
18.2 (15.1)
0.30 (2.8)
18.5 (15.3)
Northampton General Hospital
NTH
376
364
96.8
92.5
14.2
80.2
24.2
3.9
92.3
75.0
18.9 (13.5)
6.02 (18.2)
24.9 (23.5)
PIL
330
311
94.2
97.7
82.3
99.7
28.9
1.4
93.0
99.7
15.2 (10.3)
0.38 (3.7)
15.6 (10.6)
UHN
830
739
89.0
94.0
84.4
90.8
98.9
1.5
74.9
98.5
15.2 (11.1)
2.02 (7.4)
17.3 (12.7)

University Hospital Nottingham
EAST MIDLANDS
Mean (SD) length of acute stay

(days)
% Patients developing pressure

ulcers (BB Std 4)
390
% Falls assessment (BB Std 6)
% Pre-operative assessment by
geriatrician (BB Std 3)
% Surgery within 48hrs (BB Std 2)
% Admitted to orthopaedic care

within 4hrs (BB Std. 1)
% Data completeness of reporting

fields
CHE
% case ascertainment
Hospital code
Chesterfield Royal Hospital
Number of cases submitted
Hospital
Leicester Royal Infirmary
65
Estimated number of hip fractures

(Facilities Audit)
East Midlands
4446
4011
90.2
92.7
62.8
90.9
47.8
2.9
83.1
96.9
16.0 (12.7)
2.2 (9.3)
18.3 (15.6)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
85.0
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
Addenbrookes Hospital, Cambridge
Mean (SD) total length of

stay acute + post-acute
(days)
Mean (SD) length of postacute stay (days)
Mean (SD) length of acute

stay (days)
% Falls assessment
(BB Std 6)

% Patients developing
pressure ulcers (BB Std 4)
% Pre-operative assessment
by geriatrician (BB Std 3)
% Surgery within 48hrs (BB

Std 2)
% Admitted to orthopaedic
care within 4hrs (BB Std. 1)
% Data completeness of
reporting fields
ADD
480
450
93.8
94.5
59.9
83.0
84.6
4.3
96.7
99.8
16.5 (10.3)
0.24 (3.5)
16.7 (10.7)
Basildon and Thurrock University Hospital
BAS
388
405
104.4
98.5
17.9
85.0
78.5
1.7
99.5
99.7
19.2 (15.9)
0.14 (1.5)
19.3 (15.9)
Bedford Hospital
BED
220
176
80.0
93.5
66.3
85.1
44.4
0.6
4.4
98.7
23.4 (19.4)
0.28 (2.6)
23.7 (19.4)
Broomfield Hospital
BFH
468
378
80.8
88.3
86.4
91.0
99.5
1.4
81.3
100.0
6.3 (6.3)
8.35 (9.2)
14.6 (11.3)
Colchester General Hospital
COL
550
520
94.5
92.5
44.8
87.5
7.9
2.8
92.4
94.9
14.1 (10.1)
0.71 (3.8)
14.8 (10.4)
East & North Herts
ENH
480
443
92.3
95.3
70.3
91.4
93.0
0.8
92.2
100.0
18.8 (12.5)
0.84 (5.0)
19.6 (13.4)
Hinchingbrooke Hospital
HIN
200
152
76.0
89.3
51.4
83.4
51.3
1.5
90.6
75.0
20.1 (16.8)
1.86 (6.2)
22.0 (18.3)
Ipswich Hospital
IPS
438
436
99.5
94.2
85.7
85.9
70.4
0.2
88.3
100.0
16.3 (10.7)
0.42 (2.1)
16.8 (10.8)
James Paget University Hospital, Great Yarmouth
JPH
400
340
85.0
97.0
36.0
88.7
20.9
6.0
92.6
99.4
12.2 (8.8)
5.76 (15.8)
18.0 (18.7)
Luton and Dunstable Hospital
LDH
300
305
101.7
93.7
22.4
88.9
96.7
6.5
87.0
99.6
17.1 (14.5)
1.93 (7.4)
19.0 (16.5)
Norfolk and Norwich University Hospital
NOR
800
735
91.9
98.6
45.3
88.2
38.2
6.2
86.1
96.7
16.2 (11.6)
0.00 (0.0)
16.2 (11.6)
The Princess Alexandra Hospital, Harlow
PAH
350
372
106.3
98.7
32.3
90.8
99.7
5.2
92.3
100.0
17.3 (12.3)
0.55 (3.5)
17.8 (13.6)
Peterborough District Hospital
PET
400
399
99.8
94.4
65.9
91.6
0.3
0.5
86.5
100.0
14.4 (11.5)
2.84 (9.5)
17.3 (15.2)
Queen Elizabeth Hospital, Kings Lynn
QKL
350
323
92.3
91.9
59.6
88.3
54.2
2.0
87.1
96.4
12.5 (8.3)
0.52 (4.8)
13.0 (9.1)
Southend Hospital
SEH
485
392
80.8
93.4
71.2
84.7
73.8
6.8
96.7
100.0
13.0 (8.1)
0.75 (3.4)
13.7 (7.8)
Watford General Hospital
WAT
450
455
101.1
94.6
49.5
89.1
79.3
1.0
92.1
99.8
14.2 (9.6)
1.66 (8.2)
15.9 (12.6)
West Suffolk Hospital, Bury St. Edmunds
WSH
324
284
87.7
97.4
69.7
91.3
48.6
3.8
90.9
100.0
13.4 (9.0)
6.69 (11.9)
20.1 (15.4)
EAST OF ENGLAND
66
Estimated number of hip

fractures (Facilities Audit)
Hospital
Hospital code
East of England
7083
6565
92.7
94.8
54.6
88.0
60.6
3.2
88.4
98.5
15.3 (11.9)
1.7 (7.0)
17.0 (13.4)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
Mean (SD) length of

post-acute stay (days)
Mean (SD) total length

of stay acute + postacute (days)
93.6
57.0
89.5
99.7
1.9
96.7
100.0
17.2 (11.1)
0.80 (5.2)
18.0 (12.0)
91.1
91.9
19.1
89.2
1.2
2.6
100.0
99.7
18.4 (13.7)
4.74 (12.1)
23.1 (17.7)
Chase Farm Hospital
CHS
219
190
86.8
94.4
0.0
90.2
100.0
6.3
97.6
100.0
St Georges Hospital, London
GEO
170
164
96.5
90.8
40.3
86.6
14.7
6.7
95.3
98.7
Queen Elizabeth Hospital, Woolwich
GWH
269
269
100.0
92.1
12.0
90.2
11.5
0.4
92.5
99.6
HIL
230
198
86.1
91.3
61.7
97.2
71.2
0.6
91.2
94.5
Hillingdon Hospital
Mean (SD) length of

acute stay (days)
99.0
346
% Falls assessment (BB

Std 6)
pressure ulcers (BB
Std 4)
% Bone health
medication assessment
(BB Std 5)
% Pre-operative
assessment by
% Surgery within 48hrs

(BB Std 2)
305
380
% Data completeness
of reporting fields
308
BRO
Estimated number of
hip fractures (Facilities
Audit)
BNT
Princess Royal University Hospital, Bromley
Number of cases
submitted
Hospital code
Barnet Hospital
Hospital
17.3 (13.2)
9.7 (9.0)
15.94 (15.0)
25.7 (15.5)
21.2 (16.2)
0.34 (3.0)
21.6 (16.3)
12.2 (8.2)
8.40 (13.3)
20.6 (14.3)
Homerton Hospital, London
HOM
80
84
105.0
88.5
0.0
79.5
34.9
11.0
97.3
100.0
16.3 (12.2)
11.65 (22.9)
28.0 (22.2)
Kings College Hospital, London
KCH
120
114
95.0
80.2
37.3
87.4
37.6
2.4
75.3
100.0
31.2 (25.8)
0.00 (0.0)
31.2 (25.8)
Kingston Hospital
KTH
350
288
82.3
94.3
21.8
93.8
81.6
2.2
98.2
98.5
15.5 (13.5)
0.00 (0.0)
15.5 (13.5)
University Hospital, Lewisham
LEW
170
202
118.8
94.6
48.2
87.4
79.2
0.5
88.6
99.5
16.6 (11.9)
0.15 (2.0)
16.8 (12.0)
The Royal London Hospital
LON
125
140
112.0
94.5
25.7
91.2
58.6
0.0
72.4
99.2
16.3 (12.8)
14.52 (25.9)
30.8 (27.8)
Mayday University Hospital, London
MAY
300
274
91.3
93.8
7.0
83.5
60.9
21.7
77.4
99.2
24.0 (16.8)
0.17 (1.7)
24.2 (16.8)
North Middlesex University Hospital
NMH
130
138
106.2
94.3
67.2
92.4
89.1
5.9
94.9
100.0
18.3 (14.9)
0.23 (2.4)
18.5 (15.0)
Northwick Park Hospital, London
NPH
275
245
89.1
88.5
36.8
61.0
94.2
1.4
95.9
95.9
20.3 (16.1)
0.09 (1.2)
20.4 (16.0)
Newham General Hospital, London
NWG
100
83
83.0
92.7
24.4
81.6
84.3
3.9
98.7
97.4
17.4 (11.2)
3.94 (16.9)
21.4 (19.8)
Queens Hospital, Romford
OLD
500
558
111.6
95.3
35.9
83.6
30.3
2.5
93.6
99.8
8.4 (7.0)
16.82 (18.8)
25.3 (19.8)
Royal Free Hospital, London
RFH
210
167
79.5
94.2
54.0
81.9
83.2
1.3
89.6
98.0
17.0 (14.7)
0.23 (2.0)
17.3 (14.6)
St Helier Hospital, Carshalton
SHC
440
379
86.1
94.4
33.1
98.0
88.7
4.3
77.5
99.7
17.6 (13.7)
3.27 (14.1)
20.8 (19.6)
St Thomas Hospital, London
STH
210
191
91.0
95.7
73.4
87.4
48.7
2.2
66.9
99.4
14.6 (12.1)
4.57 (13.9)
19.1 (17.1)
St. Marys Hospital, Paddington
STM
300
301
100.3
98.3
33.2
87.2
38.7
0.0
99.3
100.0
15.9 (13.5)
2.17 (7.1)
18.0 (14.3)
Chelsea and Westminster Hospital
WES
160
147
91.9
94.0
1.4
84.2
38.1
11.3
58.2
100.0
23.7 (17.3)
0.46 (4.2)
24.1 (17.9)
Whipps Cross University Hospital
WHC
320
301
94.1
93.8
18.3
89.5
83.3
4.1
99.3
99.6
16.5 (13.8)
1.73 (8.1)
18.2 (16.2)
Whittington Hospital, London
WHT
140
144
102.9
94.7
25.0
94.2
25.9
2.2
89.6
99.3
15.7 (11.4)
0.00 (0.0)
15.7 (11.4)
West Middlesex University Hospital, Isleworth
WMU
220
216
98.2
92.9
41.2
77.7
3.2
7.2
98.5
99.0
18.5 (13.7)
1.99 (10.7)
20.5 (17.0)
5726
5444
95.1
93.4
32.3
87.2
55.9
3.8
90.4
99.1 16.5 (13.9)
4.5 (12.8)
20.9 (17.3)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5 15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5 15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
LONDON
67
% Admitted to
orthopaedic care within
4hrs (BB Std. 1)
London

Mean (SD) length of post-acute

stay (days)

(days)


ulcers (BB Std 4)
% Surgery within 48hrs (BB Std

2)

reporting fields
Altnagelvin Area Hospital
ALT
387
350
90.4
90.3
20.3
72.5
2.3
6.3
20.2
0.0
10.8 (6.9)
9.78 (19.8)
20.6 (20.5)
Craigavon Hospital, Portadown
CRG
250
218
87.2
92.6
52.6
69.4
99.5
9.3
94.6
100.0
10.2 (5.5)
11.13 (18.3)
21.4 (18.4)
Ulster Hospital, Belfast
NUH
375
381
101.6
93.1
40.4
34.3
79.3
4.8
74.1
71.4
15.8 (9.0)
4.47 (9.7)
20.3 (13.3)
Royal Victoria Hospital, Belfast
RVB
924
896
97.0
89.9
37.4
52.2
97.5
1.0
71.2
97.3
11.2 (8.1)
8.56 (19.6)
19.7 (20.5)
1936
1845
95.3
90.9
36.5
54.6
75.9
3.8
64.7
73.6
12.0 (8.2)
8.1 (17.9)
20.2 (18.9)
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
NORTHERN IRELAND
OVERALL
68

Hospital
Hospital code
Northern Ireland

Mean (SD) length of post-acute

stay (days)

(days)
98.2
66.5
97.1
58.9
2.7
92.6
99.7
10.0 (7.4)
20.64 (23.0)
30.7 (24.4)
Darlington Memorial Hospital
DAR
327
351
107.3
92.4
70.7
79.2
38.7
1.0
90.4
100.0
10.3 (7.8)
11.61 (18.6)
21.9 (20.4)

95.1

ulcers (BB Std 4)
% Surgery within 48hrs (BB Std 2)

% Data completeness of reporting

fields
333
350
ASH
Hospital code
Wansbeck Hospital
Hospital
University Hospital Of North Durham, Darlington
DRY
320
356
111.3
92.3
53.0
84.9
49.2
0.9
85.8
98.7
10.7 (7.7)
13.89 (17.0)
24.6 (18.5)
University Hospital of North Tees, Stockton on Tees
NTG
380
376
98.9
93.3
82.9
90.7
35.5
12.1
92.2
100.0
15.6 (9.9)
5.72 (13.2)
21.3 (17.2)
North Tyneside General Hospital, North Shields
NTY
330
308
93.3
97.6
54.9
98.2
29.9
1.4
77.0
99.6
13.2 (11.3)
9.74 (20.1)
22.9 (22.0)
Queen Elizabeth Hospital, Gateshead
QEG
320
318
99.4
98.0
61.2
88.5
48.7
7.4
84.2
100.0
16.7 (11.4)
0.75 (4.6)
17.4 (11.7)
Royal Victoria Hospital, Newcastle
RVN
450
401
89.1
97.3
49.9
92.6
49.4
9.9
76.5
100.0
13.9 (11.3)
16.71 (24.5)
30.6 (26.3)
James Cook University Hospital, Middlesbrough
SCM
512
454
88.7
93.2
83.0
90.8
48.9
5.6
79.9
100.0
15.3 (12.1)
0.81 (4.4)
16.1 (12.5)
South Tyneside District Hospital, South Shields
STD
222
208
93.7
91.4
48.1
79.1
8.7
4.8
84.7
100.0
17.6 (13.3)
13.36 (23.8)
31.0 (27.1)
Sunderland Royal Hospital
SUN
420
385
91.7
96.0
65.5
91.2
42.0
4.7
76.5
100.0
20.8 (17.6)
0.74 (4.6)
21.5 (18.5)
NORTH EAST
69
Estimated number of hip fractures

(Facilities Audit)
North East
3631
3490
96.1
95.0
64.8
89.6
42.6
4.9
83.7
99.8
14.4 (11.8)
8.9 (17.9)
23.3 (20.5)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
% Bone health
(BB Std 5)
Mean (SD) length of


18.3
91.1
50.6
3.2
96.4
98.9
15.8 (10.0)
1.11 (8.2)
16.9 (13.2)
98.0
69.9
88.2
67.0
2.8
91.3
100.0
15.4 (13.3)
6.35 (15.6)
21.8 (19.5)
Royal Bolton Hospital
BOL
380
390
102.6
97.4
86.1
60.9
84.6
3.5
95.7
88.3
17.8 (11.2)
0.75 (6.3)
18.5 (13.1)
Cumberland Infirmary, Carlisle
CMI
250
283
113.2
97.4
70.1
92.4
19.1
0.8
67.0
39.7
12.6 (8.6)
0.58 (5.7)
13.2 (10.3)
Countess of Chester Hospital
COC
320
336
105.0
95.5
45.3
89.1
30.7
7.6
94.2
98.6
19.7 (15.0)
11.84 (22.7)
31.5 (27.0)
University Hospital Aintree
FAZ
400
380
95.0
93.5
46.1
95.7
42.1
0.6
82.6
100.0
14.2 (10.4)
10.66 (18.9)
24.9 (20.9)
Furness General Hospital, Barrow-in-Furness
FGH
120
140
116.7
92.4
52.9
93.3
13.6
6.3
96.8
100.0
22.7 (19.7)
1.50 (8.1)
24.2 (20.1)
Leighton Hospital, Crewe
LGH
280
285
101.8
92.2
67.7
81.9
18.9
3.9
91.3
97.6
17.1 (12.6)
2.04 (11.0)
19.1 (16.8)
Macclesfield General Hospital
MAC
250
246
98.4
92.7
79.0
83.4
99.6
0.9
99.5
99.6
21.1 (15.8)
4.97 (15.5)
26.0 (22.1)
Manchester Royal Infirmary
MRI
190
173
91.1
96.6
74.8
90.6
36.6
4.5
69.5
100.0
10.8 (10.2)
19.55 (23.5)
30.3 (25.0)
NMG
300
331
110.3
93.3
67.0
72.8
43.8
3.8
60.3
56.4
13.9 (12.3)
8.09 (12.9)
22.0 (16.6)
Nobles Hospital, Isle of Man
NOB
81
85
104.9
91.3
85.5
83.3
29.4
1.3
69.2
97.5
14.6 (13.8)
0.58 (3.8)
15.2 (14.0)
Royal Oldham Hospital
OHM
325
335
103.1
94.4
51.0
66.3
97.0
3.3
61.7
98.4
14.1 (9.9)
5.61 (10.7)
19.7 (14.5)
Royal Lancaster Infirmary
RLI
266
231
86.8
90.7
77.0
87.8
21.6
4.8
89.6
99.5
14.5 (10.5)
10.08 (17.3)
24.6 (19.6)
RLU
360
395
109.7
95.2
52.3
90.6
73.4
0.6
74.5
100.0
17.5 (13.0)
0.96 (5.4)
18.4 (13.7)
Royal Preston Hospital
RPH
430
390
90.7
79.7
60.6
77.2
2.8
0.9
91.5
99.7
17.1 (11.9)
6.11 (14.7)
23.2 (19.4)
Stepping Hill Hospital, Stockport
SHH
362
332
91.7
94.3
69.8
87.9
5.3
3.6
88.7
99.6
22.4 (16.8)
0.25 (2.2)
22.6 (17.1)
Hope Hospital, Salford
SLF
220
223
101.4
94.2
62.3
90.2
22.0
2.1
55.8
95.5
14.6 (13.2)
3.15 (15.4)
17.7 (20.8)
Southport District General Hospital
SOU
263
270
102.7
93.8
56.3
85.4
0.4
0.0
0.0
97.2
13.8 (9.8)
2.90 (8.2)
16.7 (13.8)
Tameside General Hospital, Manchester
TGA
350
224
64.0
94.6
57.8
74.0
95.5
0.5
94.0
99.0
17.2 (14.2)
0.38 (3.1)
17.6 (14.5)
Trafford General Hospital, Manchester
TRA
110
104
94.5
94.2
70.9
81.1
22.1
1.1
100.0
100.0
27.8 (22.0)
1.67 (8.8)
29.5 (24.5)
Victoria Hospital, Blackpool
VIC
480
414
86.3
97.1
60.7
84.5
1.4
5.2
85.1
94.6
14.1 (10.6)
7.98 (15.3)
22.1 (17.9)
West Cumberland Hospital, Whitehaven
WCI
150
131
87.3
89.1
75.2
73.4
1.6
3.5
31.6
0.0
17.4 (14.0)
0.25 (2.2)
17.6 (14.2)
Warrington Hospital
WDG
330
284
86.1
94.1
61.2
88.6
9.9
3.5
83.3
100.0
19.5 (13.5)
3.80 (9.4)
23.3 (15.4)
Whiston Hospital, Prescot
WHI
406
387
95.3
93.5
15.2
91.1
39.5
0.3
89.6
94.4
17.2 (12.6)
7.89 (16.0)
25.0 (19.7)
Arrowe Park Hospital, Wirral
WIR
461
462
100.2
97.1
67.8
93.4
59.9
12.4
82.7
96.6
17.5 (12.9)
6.06 (12.3)
23.6 (16.7)
Wythenshawe Hospital, Manchester
WYT
274
291
106.2
94.3
15.9
88.1
50.2
2.0
99.6
100.0
21.0 (17.6)
8.35 (17.2)
29.3 (23.5)
8088
7901
97.7
94.1
58.1
84.8
41.5
3.2
80.6
92.3
16.8 (13.2)
5.2 (13.8)
22.0 (18.6)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.8
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
NORTH WEST
70
Mean (SD) length of

acute stay (days)
pressure ulcers (BB
Std 4)
97.4
115.8

Std 6)
% Pre-operative
assessment by
95.8
463
% Surgery within
48hrs (BB Std 2)
316
400
% Admitted to
orthopaedic care
330
BLA
% Data completeness
of reporting fields
AEI
Royal Blackburn Hospital
Estimated number of
hip fractures (Facilities
Audit)
Royal Albert Edward Infirmary, Wigan
Hospital
Number of cases
submitted
Hospital code
North West

(days)
51.4
91.0
48.3
2.2
82.4
100.0
15.8 (17.6)
3.58 (10.5)
19.4 (19.5)
St.Marys Hospital, Isle of Wight
IOW
250
250
100.0
94.5
54.2
82.3
93.2
0.9
4.5
93.3
12.7 (10.6)
3.39 (9.7)
16.1 (14.1)
Milton Keynes General Hospital
MKH
220
109
49.5
96.3
22.9
90.2
44.0
6.4
89.2
69.6
21.9 (17.5)
3.89 (9.5)
25.8 (19.8)
Basingstoke & N.Hants Hospital
NHH
220
242
110.0
94.9
57.6
91.0
71.1
5.6
84.8
98.5
17.7 (12.7)
2.71 (10.8)
20.5 (16.9)
Queen Alexandra Hospital, Portsmouth
QAP
688
732
106.4
99.1
82.8
89.5
92.9
1.3
93.8
100.0
14.8 (10.3)
1.79 (6.2)
16.6 (11.5)
John Radcliffe Hospital, Oxford
RAD
480
526
109.6
86.1
54.1
86.5
76.2
3.8
82.4
98.2
11.6 (9.1)
1.06 (7.4)
12.7 (11.8)

94.0

stay (days)
% Falls assessment (BB Std

6)

Std 2)
84.6
reporting fields
148
175

HOR
Hospital code
Horton Hospital, Banbury
Hospital
Royal Berkshire Hospital, Reading
RBE
492
449
91.3
95.7
22.9
90.3
75.1
2.0
90.4
100.0
10.8 (10.6)
6.46 (11.5)
17.2 (13.4)
Royal Hampshire County Hospital, Winchester
RHC
239
273
114.2
98.5
33.9
93.6
99.3
2.5
55.2
100.0
16.0 (11.6)
6.80 (16.0)
22.8 (18.8)
Southampton General Hospital
SGH
625
569
91.0
88.5
51.0
85.2
80.1
4.4
88.3
98.0
17.6 (13.2)
0.24 (2.2)
17.9 (13.3)
Stoke Mandeville Hospital, Aylesbury
SMV
380
391
102.9
93.3
8.1
87.8
56.7
0.3
92.5
97.8
15.3 (13.6)
6.75 (18.2)
22.0 (21.8)
Wexham Park Hospital, Slough
WEX
330
338
102.4
90.2
28.4
91.7
49.3
4.9
94.8
95.4
17.2 (17.0)
1.28 (8.2)
18.5 (18.6)
4099
4027
98.2
93.4
46.8
88.6
75.9
2.7
81.9
97.6
14.9 (12.7)
3.0 (10.4)
18.0 (15.7)
SOUTH CENTRAL
71
South Central
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
318
286
Eastbourne Hospital
DGE
410
Darent Valley Hospital, Dartford
DVH
278
East Surrey Hospital, Redhill
ESU
Frimley Park, Camberley
89.9
98.5
30.9
90.7
373
91.0
94.4
28.5
96.1
336
120.9
95.5
24.1
71.1
510
509
99.8
90.8
35.4
94.3
FRM
330
365
110.6
97.4
35.3
Medway Maritime Hospital
MDW
375
339
90.4
97.6
Queen Elizabeth the Queen Mother Hospital, Margate
QEQ
400
372
93.0
93.8
Royal Sussex County Hospital, Brighton
RSC
570
429
75.3
Royal Surrey County Hospital, Guildford
RSU
357
330
St Peters Hospital, Chertsey
SPH
410
St Richards Hospital, Chichester
STR
350
Maidstone & Tunbridge Wells
TUN
William Harvey Hospital, Ashford

Worthing + Southlands Hospital
4.2
93.9
9.1
3.5
48.6
17.7
42.9
91.5
51.6
68.8
94.5
92.4
441
349
460
WHH
WRG

(days)

stay (days)

95.4
17.5 (13.7)
0.49 (3.2)
18.0 (13.7)
86.8
98.8
15.1 (10.3)
2.80 (10.7)
17.9 (15.3)
93.2
100.0
18.3 (17.1)
2.52 (8.1)
20.9 (19.1)
4.5
94.0
100.0
21.9 (19.8)
0.51 (3.7)
22.4 (20.0)
11.2
0.3
97.2
100.0
16.8 (15.9)
2.49 (9.3)
19.3 (18.2)
89.3
20.6
1.6
87.1
99.4
15.1 (12.2)
0.48 (4.4)
15.5 (12.8)
89.7
77.9
1.2
96.4
100.0
17.5 (12.9)
3.92 (13.5)
21.4 (19.2)
43.0
94.6
59.4
8.6
88.0
97.8
6.8 (8.1) 12.89 (12.9)
19.7 (14.8)
94.0
29.2
93.5
57.9
4.4
79.1
99.7
107.6
97.7
66.7
95.7
73.9
8.3
94.2
100.0
99.7
94.5
3.2
92.6
66.1
1.0
89.8
95.7
351
76.3
91.0
41.1
89.5
16.0
5.0
88.9
62.1
385
423
109.9
96.2
35.6
87.1
83.9
6.9
84.2
100.0
17.5 (13.1)
435
503
115.6
97.1
0.6
95.0
90.9
0.4
87.3
100.0
5588
5406
96.7
95.1
35.2
91.2
49.8
4.8
90.0
96.7
15.5 (14.3)
4.4 (11.5)
19.8 (16.8)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.6
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
SOUTH EAST COAST
2.1

Std 2)
reporting fields
CGH
Conquest Hospital, Hastings
72

Hospital
Hospital code
South East Coast
21.1 (17.8)
0.55 (6.4)
21.6 (18.6)
11.7 (9.5) 10.09 (14.1)
21.8 (15.4)
12.4 (9.2)
0.39 (2.1)
12.8 (9.0)
9.3 (7.9) 13.09 (17.5)
22.4 (18.0)
1.90 (11.8)
19.4 (18.2)
19.2 (13.6)

(days)
489
88.9
93.4
41.5
92.6
94.0
1.1
88.1
100.0
14.9 (11.4)
0.42 (3.3)
15.3 (11.7)
Bristol Royal Infirmary
BRI
400
345
86.3
98.6
12.0
72.2
42.9
6.2
71.5
100.0
19.5 (15.8)
8.30 (17.5)
27.8 (22.1)
CHG
300
299
99.7
96.0
72.4
71.2
86.0
1.5
88.0
100.0
14.4 (10.2)
0.38 (3.2)
14.8 (10.5)
Frenchay Hospital, Bristol
FRY
420
433
103.1
95.8
17.5
93.7
65.5
6.4
84.8
100.0
23.5 (16.0)
0.53 (6.2)
24.1 (16.9)
Gloucester Royal Hospital
GLO
400
418
104.5
98.5
71.8
91.5
55.5
1.9
84.1
98.9
15.2 (9.8)
0.47 (5.6)
15.7 (10.9)
Musgrove Park Hospital, Taunton
MPH
400
368
92.0
92.4
68.8
91.4
63.2
1.7
91.2
98.8
13.6 (9.8)
0.79 (5.5)
14.4 (10.7)
North Devon District Hospital, Barnstaple
NDD
250
260
104.0
92.1
87.8
81.6
5.8
6.1
82.5
100.0
10.4 (7.1)
13.49 (18.8)
23.9 (20.7)
Poole General Hospital
PGH
899
859
95.6
97.0
63.9
86.7
72.4
1.9
92.4
100.0
12.2 (10.1)
0.11 (1.7)
12.3 (10.3)
Derriford Hospital, Plymouth
PLY
481
570
118.5
94.4
49.0
81.2
46.3
0.0
84.4
99.6
12.1 (6.9)
0.42 (3.0)
12.5 (7.3)
The Great Western Hospital, Swindon
PMS
375
376
100.3
97.0
74.7
95.4
65.7
4.5
69.3
99.7
16.4 (13.1)
2.72 (9.8)
19.1 (16.3)
The Royal Cornwall Hospital, Treliske
RCH
555
639
115.1
95.1
81.6
85.3
67.0
1.2
81.8
99.5
12.5 (9.5)
0.76 (4.2)
13.2 (10.2)
Royal Devon & Exeter Hospital, Exeter
RDE
510
522
102.4
99.5
71.3
90.1
65.5
1.2
83.9
99.8
11.6 (7.1)
0.45 (3.1)
12.0 (7.6)
Salisbury District Hospital
SAL
250
278
111.2
94.3
78.4
90.8
97.5
0.8
100.0
100.0
19.0 (17.8)
1.92 (8.0)
20.9 (19.0)
Torbay District General Hospital
TOR
460
436
94.8
95.2
28.1
82.1
74.8
1.2
98.5
98.5
8.8 (4.6)
1.70 (6.6)
10.5 (8.0)
Dorset County Hospital, Dorchester
WDH
255
256
100.4
90.1
92.1
92.5
2.4
1.3
41.1
99.6
10.5 (8.5)
0.00 (0.0)
10.5 (8.5)
Weston General Hospital, Weston-Super-Mare
WGH
400
224
56.0
89.2
61.4
92.2
21.9
9.7
86.3
86.3
16.3 (13.3)
5.51 (13.2)
21.9 (18.2)
Yeovil District Hospital
YEO
250
190
76.0
91.2
45.0
87.2
31.1
7.6
82.2
86.1
15.3 (13.4)
0.63 (2.9)
15.9 (13.5)
SOUTH WEST

stay (days)


Std 2)
550
reporting fields
BAT
Hospital code
Royal United Hospital, Bath

Hospital
Cheltenham General Hospital
73
South West
7155
6962
97.3
95.3
59.8
86.9
60.9
2.7
84.4
98.8
14.1 (11.4)
1.7 (7.9)
15.8 (13.7)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)

(days)

stay (days)


Std 2)
reporting fields
Bronglais Hospital, Aberystwyth
BRG
95
92
96.8
86.2
43.5
56.8
51.1
4.8
33.7
1.2
16.4 (10.5)
4.58 (12.8)
21.0 (16.5)
Glan Clwyd Hospital, Rhyl
CLW
365
339
92.9
89.2
53.0
88.7
6.5
5.9
82.7
0.0
13.8 (13.2)
19.99 (25.9)
33.8 (28.6)
Royal Gwent Hospital, Newport
GWE
310
352
113.5
92.5
13.4
71.6
29.2
2.5
87.4
98.2
20.1 (17.9)
14.26 (28.3)
34.3 (34.1)
Gwynedd Ysbyty, Bangor
GWY
280
228
81.4
85.2
50.9
82.4
30.7
1.9
79.5
98.6
13.0 (12.0)
19.22 (20.0)
32.2 (21.3)
Morriston Hospital, Swansea
MOR
450
534
118.7
91.4
32.8
80.4
0.4
2.9
80.5
87.4
19.5 (16.9)
14.92 (25.6)
34.5 (30.2)
Nevill Hall Hospital, Abergavenny
NEV
300
254
84.7
89.2
24.2
81.6
57.9
2.2
80.8
78.2
17.5 (13.6)
15.25 (29.5)
32.7 (32.1)
Prince Charles Hospital, Merthyr Tydfil
PCH
220
131
59.5
86.3
29.1
82.8
17.6
3.6
4.5
0.0
20.5 (16.4)
10.79 (22.7)
31.3 (26.8)
Princess Of Wales Hospital, Bridgend
POW
300
240
80.0
86.0
13.8
75.7
3.3
2.5
49.3
35.2
20.6 (17.3)
6.28 (17.6)
26.9 (23.7)
Royal Glamorgan Hospital, Llantrisant
RGH
275
243
88.4
83.1
18.5
76.1
4.9
0.5
76.1
99.2
14.4 (9.9)
21.14 (36.7)
35.6 (37.6)
University Hospital of Wales, Cardiff
UHW
500
510
102.0
86.9
14.1
73.2
59.1
0.7
85.2
99.3
26.6 (23.7)
12.27 (29.0)
38.9 (35.6)
Maelor Hospital, Wrexham
WRX
235
266
113.2
91.9
71.6
84.2
32.3
1.7
47.3
96.6
14.8 (11.9)
15.96 (28.6)
30.8 (29.4)
West Wales General Hospital, Carmarthen
WWG
300
332
110.7
86.2
58.2
84.6
46.9
1.1
91.4
87.5
18.9 (11.6)
29.04 (32.3)
48.0 (34.5)
Withybush Hospital, Haverford West
WYB
180
144
80.0
86.2
55.6
74.8
6.5
4.1
96.8
86.5
17.7 (11.3)
10.34 (19.0)
28.0 (22.1)
3810
3665
96.2
88.3
35.0
78.8
26.9
2.4
74.8
74.1
18.6 (16.6)
14.7 (26.9)
33.2 (30.6)
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
WALES
OVERALL
74

Hospital
Hospital code
Wales


Std 6)
90.8
10.4
2.2
98.5
95.1
19.3 (16.7)
0.00 (0.0)

(days)
60.7
92.5

stay (days)

Std 2)
105.4
19.3 (16.7)
Birmingham Heartlands
EBH
480
482
100.4
95.7
7.5
83.0
85.0
6.5
35.4
91.7
19.6 (16.0)
6.13 (14.0)
25.7 (18.7)
Good Hope Hospital, Birmingham
GHS
380
365
96.1
96.1
15.7
77.8
89.3
4.9
85.5
94.8
19.0 (14.6)
2.01 (9.0)
21.0 (16.5)
County Hospital, Hereford
HCH
282
285
101.1
92.4
57.9
91.0
23.2
1.7
83.2
96.4
11.1 (7.4)
0.12 (1.9)
11.2 (7.6)
New Cross Hospital, Wolverhampton
NCR
336
367
109.2
95.4
29.9
89.6
71.0
9.9
87.0
93.3
16.5 (16.0)
1.63 (7.7)
18.2 (17.4)
George Eliot Hospital, Nuneaton
NUN
240
252
105.0
98.7
33.2
80.9
57.1
15.2
67.9
100.0
20.0 (13.8)
1.80 (7.2)
21.8 (14.7)
Queen Elizabeth Hospital, Birmingham
QEB
375
414
110.4
90.2
50.7
88.1
54.6
13.3
93.4
100.0
17.3 (17.0)
8.08 (16.0)
25.4 (20.2)
Alexandra Hospital, Redditch
RED
250
250
100.0
94.2
44.7
79.1
99.2
0.9
96.8
100.0
14.3 (9.5)
1.93 (9.8)
16.2 (13.6)
Royal Shrewsbury Hospital
RSS
350
325
92.9
89.4
39.6
58.8
42.6
1.3
79.2
88.1
17.1 (16.4)
4.57 (10.3)
21.7 (19.7)
Russells Hall Hospital, Dudley
RUS
500
485
97.0
98.8
38.9
96.1
46.8
5.0
89.3
99.8
18.2 (15.1)
0.11 (2.2)
18.3 (15.2)
Sandwell General Hospital
SAN
360
337
93.6
93.2
60.3
87.4
71.2
6.7
83.6
98.0
18.0 (15.9)
8.23 (19.7)
26.2 (24.8)
Stafford Hospital
SDG
230
230
100.0
96.1
64.3
93.4
60.4
5.7
80.8
99.0
17.3 (14.5)
4.31 (12.5)
21.6 (18.3)
University Hospital of North Staffordshire, Stoke-on Trent
STO
550
595
108.2
93.6
65.2
86.7
36.6
3.9
67.3
98.4
9.3 (7.2)
0.08 (1.1)
9.3 (7.2)
Princess Royal Hospital, Telford
TLF
225
141
62.7
86.9
58.6
75.0
3.6
0.0
74.1
78.2
9.5 (10.5)
10.12 (15.5)
19.6 (17.9)
University Hospital Coventry
UHC
518
486
93.8
98.1
43.5
92.3
3.7
0.9
95.5
100.0
15.4 (12.2)
8.31 (15.2)
23.7 (18.8)
Warwick Hospital
WAR
365
295
80.8
96.5
58.7
91.2
90.8
2.5
97.4
100.0
18.6 (17.2)
6.96 (16.8)
25.6 (24.3)
Manor Hospital, Walsall
WMH
365
311
85.2
94.1
23.2
85.5
30.9
2.2
96.0
100.0
12.1 (9.1)
5.93 (11.8)
18.0 (14.6)
Worcestershire Royal Hospital, Worcester
WRC
425
412
96.9
91.9
61.6
82.8
45.9
0.5
73.9
100.0
10.3 (8.5)
6.08 (13.2)
16.3 (15.7)
6509
6325
97.2
94.4
44.3
85.8
51.4
4.7
81.2
96.9
15.6 (14.0)
4.0 (11.9)
19.6 (17.8)
WEST MIDLANDS
75
293
278
reporting fields
BRT

Queens Hospital, Burton upon Trent
Hospital
Hospital code
West Midlands
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.8
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)

Mean (SD) length of

Mean (SD) length of

acute stay (days)

Std 6)
% Bone health
(BB Std 5)
% Pre-operative
assessment by
% Surgery within 48hrs

(BB Std 2)
% Admitted to
orthopaedic care within
4hrs (BB Std. 1)
reporting fields
Number of cases
submitted
Airedale General Hospital
AIR
270
275
101.9
94.2
51.2
89.5
54.5
2.8
93.3
100.0
17.6 (13.6)
0.81 (2.9)
18.4 (13.4)
Barnsley Hospital
BAR
590
250
42.4
93.9
56.0
90.1
32.4
4.0
94.3
100.0
16.8 (9.9)
0.37 (5.7)
17.1 (11.0)
Bradford Royal Infirmary
BRD
365
350
95.9
95.3
52.7
79.5
62.9
0.8
76.8
86.9
14.9 (9.5)
0.04 (0.6)
15.0 (9.5)
Bassetlaw Hospital
BSL
150
168
112.0
94.8
48.2
84.6
28.6
0.7
95.9
100.0
15.2 (10.3)
0.64 (4.5)
15.9 (10.7)
Doncaster Royal Infirmary
DID
350
371
106.0
94.0
46.9
84.3
44.2
0.6
94.8
100.0
13.8 (9.0)
5.71 (16.0)
19.5 (18.0)
Diana Princess of Wales Hospital, Grimsby
GGH
255
248
97.3
93.0
62.2
73.9
45.5
8.8
87.9
96.3
14.4 (9.6)
0.22 (2.2)
14.6 (9.9)
Harrogate District Hospital
HAR
260
286
110.0
94.3
72.7
90.4
47.9
3.7
62.4
97.4
16.3 (11.0)
3.91 (10.8)
20.2 (15.3)
Hull Royal Infirmary
HRI
500
538
107.6
94.7
65.4
81.0
54.4
0.4
85.9
99.8
16.5 (10.3)
0.90 (6.2)
17.4 (11.5)
Huddersfield Royal Infirmary
HUD
503
445
88.5
94.3
63.8
85.7
21.0
1.1
81.2
0.3
18.1 (15.3)
6.01 (17.6)
24.1 (23.2)
Leeds General Infirmary
LGI
700
639
91.3
89.5
49.8
74.5
41.3
5.1
91.4
93.5
19.5 (14.2)
1.86 (8.5)
21.4 (16.1)
Northern General Hospital, Sheffield
NGS
620
588
94.8
92.6
69.6
93.9
83.0
6.2
81.6
98.7
20.1 (16.5)
2.19 (8.0)
22.3 (16.5)
Pinderfields General Hospital, Wakefield
PIN
560
530
94.6
98.5
25.7
80.6
60.0
3.5
96.2
100.0
17.7 (11.9)
1.09 (5.6)
18.8 (12.9)
Rotherham District General Hospital
ROT
300
275
91.7
97.6
80.9
86.5
98.5
1.7
92.1
100.0
19.4 (15.4)
1.84 (7.7)
21.3 (16.8)
Scarborough General Hospital
SCA
267
294
110.1
93.1
52.4
91.8
57.6
3.8
85.9
98.2
10.0 (7.1)
6.12 (12.3)
16.2 (14.4)
Scunthorpe General Hospital
SCU
224
242
108.0
95.6
71.7
71.4
68.2
0.9
93.8
100.0
10.5 (6.7)
0.84 (4.2)
11.3 (7.6)
York Hospital
YDH
400
368
92.0
98.1
83.2
85.6
59.0
0.6
73.4
99.7
15.9 (10.2)
1.84 (8.9)
17.7 (13.3)
6314
5867
92.9
94.4
58.5
83.8
54.4
2.7
86.4
91.0
16.6 (12.4)
2.2 (9.4)
18.8 (15.1)
ENGLAND
58639
55998
95.5
94.3
51.6
87.3
53.8
3.5
84.9
96.5
15.6 (12.9)
3.6 (11.5)
19.2 (16.6)
OVERALL
64385
61508
95.5
93.9
50.2
85.9
52.9
3.5
83.8
94.5
15.7 (13.0)
4.3 (13.1)
20.0 (17.8)
YORKS & HUMBER
76

Hospital
Hospital code
Yorkshire and the Humber

Glossary
Term
Definitions
Abbreviated
mental test score
A rapid assessment of elderly patients to assess cognitive dysfunction.
Arthroplasty
Any replacement of the upper femur including unipolar hemi-arthroplasties,

bipolar hemi-arthroplasties and total hip replacements.
ASA grades
American Society of Anesthesiologists11 (ASA) physical status classification:

1 A normal healthy patient
2 A patient with a mild systemic disease
3 A patient with a severe systemic disease that limits activity, but is not
incapacitating
4 A patient with an incapacitating systemic disease that is a constant threat to
life
5 A moribund patient not expected to survive 24 hours with or without
operation
This grading does not take into account acute illness, hence a patient can be
ASA 1 and unfit.
Bone protection
therapy
1. Bisphosphonates
Etidronate
Alendronate
Risedronate
Ibandronate
Zoledronate
Pamidronate
2. Denosumab
3. HRT and SERMS
HRT (various)
Tibolone
Raloxifene
4. Parathyroid hormone
PTH 1-34
PTH 1-84
5. Strontium
Strontium ranelate
6. Calcium and vitamin D
Calcitriol
Calcium and vitamin D various
Alpha-calcidol (or one alpha)
7. Calcitonin
Term
Definitions
Case
ascertainment
The number of cases submitted by the participating hospital divided by the

number of cases predicted, expressed as a percentage.
Cementing of
arthroplasties
Polymethyl methacrylate is a plastic that may be used to hold arthroplasties in

place. It is introduced into the reamed bone before prostheses are inserted. The
cement sets in a few minutes.
Falls prevention
assessment
A systematic assessment by a suitably trained person e.g. Geriatrician or a

specialist trained nurse which must cover the following domains: Falls history
(noting previous falls), cause of index fall (including medication review), risk
factors for falling and injury (including fracture) and from this information
formulate and document a plan of action to prevent further falls.
Foundation
Doctor
A newly qualified junior doctor undertaking two years of supervised clinical

practice prior to embarking on specialist training.
Fracture Liaison
Nurse/service
A nurse whose primary purpose is to ensure that both inpatients and outpatients
with low impact fractures are screened for falls and osteoporosis.
Multidisciplinary
rehabilitation
team
A group of people of different professions (and including as a minimum

a physiotherapist, occupational therapist, nurse and doctor) with job plan
responsibilities for the assessment and treatment of hip fracture patients, and
who convene (including face to face or virtual ward round) regularly (and at
least weekly) to discuss patient treatment and care, and plan shared clinical care
goals.
Pressure ulcer13
A pressure ulcer is an area of localised damage to the skin and underlying tissue
caused by pressure, shear or friction forces, or a combination of these.
Sprint Audit
Short term audit of specific fields/areas of practice.
ST3 level
A doctor in the third year of specialist training.
Superspell
Overall NHS length of stay: including acute care and any post-acute care/
rehabilitation care prior to return home; or to admission to care home care; to
other non-NHS placement; or death.
78

References
1. British Orthopaedic Association. The Care of patients with fragility fracture. Br Orthop Ass 2007.
Available from: http://www.boa.ac.uk
2. Best Practice Tariff. http://www.dh.gov.uk/health/2012/02/confirmation-pbr-arrangements/
3. National Institute for Clinical Excellence, 2011, www.nice.org.uk/guidance/CG124
4. National Institute for Clinical Excellence, 2012, www.nice.org.uk/guidance/QS16
5. Maxwell MJ, Moran CG, Moppett IK. Development and validation of a pre-operative scoring system
to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth 2008;101:511
6. Griffiths, R et al. Management of proximal femoral fractures 2011. Anaesthesia 2012, vol 67, pp
8598
7. Spiegelhalter, DJ. Funnel plots for comparing institutional performance. Statistics in Medicine
20052411851202
8. Handling over-dispersion of performance indicators. Spiegelhalter, DJ. 2005, Quality and Safety in
Health Care, Vol. 14, p. 347.
9. Seaton SE, Barker L, Lingsma HF, Steyerberg EW, Manktelow BN. What is the probability of
detecting poorly performing hospitals using funnel plots? BMJ Qual Saf bmjqs-2012-001689
Published Online First:5 July 2013
10. National Clinical Audit Advisory Group, for the Healthcare Quality Improvement Partnership (HQIP)
and Department of Health. Detection and management of outliers. 2011.
11. American Society of Anaesthesiologists (1963). New classification of physical status.
Anaesthesiology 1963 vol. 24 p111.
12. HES: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937
13. European Pressure Ulcer Advisory Panel (1999) Guidelines on treatment of pressure ulcers. EPUAP
Review 1, 3133
14. Clinical Commissioning Groups Outcomes Indicators Set http://www.england.nhs.uk/ccg-ois/
Appendix A
Using audit to improve care
Improving care and achieving Best Practice Tariff:
Airedale NHS Foundation Trust
In May of 2011 Airedale NHS Foundation Trust started an orthogeriatrics service. The specific aims of
the service were to achieve Best Practice for patients with fracture neck of femurs based on the Blue
Book indicators. The service started from a zero starting point, where no patients were submitted by
Airedale NHS Foundation Trust to the National Hip Fracture Database.
The overall aim is to provide optimal medical, surgical and anaesthetic care to patients who have been
part of the service.
The service is based on a small team, all located within the same site. This service has been implemented
and grown considerably within the last 24 months, based on a strong multidisciplinary team ethic and
close working between Geriatrics, Orthopaedics, Anaesthetics and Emergency Department. The Nurse
specialist has been key to coordinating the links between the specialities.
The key to the success has been a neck of fracture trauma board and a neck of fracture spreadsheet
being kept to highlight all the key indicators to be achieved.
Other initiatives have included close collaboration with the Emergency Department to ensure femoral
nerve blocks are done to reduce opiate anaesthesia, nursing care pathways assist in the management of
the patient and a neck of femur patient and relative information booklet.
This service has grown to achieve 70%, Best Practice in the first year .The subsequent year 201213 has
shown a further improvement in the service to 79%. The length of stay in hospital for these patients
has fallen significantly. In recognition of these achievements, the service was shortlisted for a Healthcare
Innovations award in 2012.
Improving care and reducing time to theatre:

North Manchester General Hospital now accepts orthopaedic trauma for both North Manchester and
Bury following a reconfiguration of services in March 2012. At this time there was Orthogeriatric cover
for hip fracture patients for only 3 half days per week.
In order to improve the service, a Multidisciplinary Service Development Group (MSDG) was set up and
we have now gained a full time Orthogeriatrics Consultant in February of this year and a (currently
locum) Orthogeriatrics Speciality Doctor. The MSDG meets once a month to identify problems and
provide solutions.
Our figures have improved dramatically. In June 2013 average time to theatre was 31 hours and average
length of stay was 7 days compared to March 2012 when average time to theatre was 57 hours and
length of stay 20 days.
80

After attending the Northwest Hip Fracture Meeting in March 2013 the MSDG uses information from
this day and continues to work on improving the service for our patients. Achievement of the Best
Practice Tariff has improved from 10% in quarter 4 of 201213 (when there was no consistent OG
cover) to 33% in quarter 1 of 201314.
Using audit data to improve practice:

Calderdale and Huddersfield NHS Foundation Trust
In February 2010, Calderdale and Huddersfield NHS Foundation Trust (CHFT) appointed a dedicated
Trauma Co-ordinator as a result of the Rapid Improvement Programme for Orthopaedics in 2008. This
was increased to 1.6 whole time equivalent (WTE) in September 2011. Prior to February 2010, NHFD
data entry was sporadic, as was data completeness. This was due to data collection not being the
responsibility of a specific member of staff.
As is nationally expected, the number of fractured neck of femur patients has increased from 415 in
200910 to 477 in 201213. We currently have an average time to theatre of 33 hours and length of
stay averages 22.7 days.
In March 2013, CHFT was highlighted as being an outlier of 30 day mortality at 13.1% in 201112.
Once aware of this situation, we sought an external opinion for advice on where we could improve
the care we provide. As a result, a multidisciplinary review lead by the British Orthopaedic Association
was instigated. They visited in May 2013, and after a review of data and documentation, key staff were
interviewed. The following day, feedback was provided.
As a Trust, we felt both inspired and invigorated by their positive, supportive outlook. Current good
practice in the ward environment was complimented upon. They also acknowledged that changes had
already been made and suggested other areas worth considering for improvement.
Whilst we await formal feedback, our practices continue to evolve, and we look forward to reporting
significant improvements in the near future.
Improving care:
University Hospital Lewisham
Following significant delays in times to theatre in 2010 and early 2011, the pre-operative assessment
of the patients was changed to include the outreach consultant anaesthetist as well as consultant
orthogeriatrician, to ensure optimisation to theatre and to plan post-operative care. In addition
integration with community providers has allowed in-reach of teams to allow earlier supported
discharge.
In 2011/12 an average of 62% of patients were in theatre within 36 hours. Delays were due to lack of
theatre space and medically unfit. In 201213 75% of patients to theatre within 36 hours.
63% of patients are discharged straight back to their own home compared to 42% in 201011, with an
average length of stay reduced 5 days to 18.4 days in 201112 compared to 24.1 days in 201011 and
readmissions have almost halved (16% to 8.8%).
Improving care and reducing length of stay:

James Cook Hospital
In September 2012 a generic multi-speciality trauma admissions unit underwent a transition to a
dedicated hip fracture ward. Communication in discharge planning has been improved through single
site physiotherapy and occupational therapy teams, a ward-based social worker, daily MDT meetings
with input from an Orthogeriatrician.
The morning trauma meeting has moved, and the hip fracture unit is visited first on the daily trauma
round to enable senior decision makers to integrate with ward staff and the anaesthetic team in
coordination of care.
A change of approach across many domains has led to:
average acute LOS decreasing by 6 days in the first six months from 20 days to 14 days
40% of patients return directly home from the acute ward, but this is achieved earlier 11.5 days
compared to 16 day previously
a further 35% of patients return to their original residence after rehabilitation in one of the
community hospitals
risk of pressure sores and inpatient falls both appear to have been reduced by single site care.
Improving care and reducing pressure ulcer incidence:

The Royal Liverpool University Hospital first joined the NHFD back in 2008. In 2010 NHFD report we
found 7% patients developing pressure ulcers (national 3.9%). A multidisciplinary team initiative was set
up resulting in 0.9% patients developing pressure ulcers by 2012.
Our project Sustaining the reduction of pressure ulcers in patients with hip fracture was recently
awarded the Eva Higgins Prize at the British Geriatrics Society Scientific meeting.
The NHFD has provided us with a great platform for improvements; we present our data monthly to our
orthopaedic trauma directorate and aim to constantly improve the care we deliver with monthly action
plans.
Not only have we seen year by year improvements in best practice in the form of Blue Book Standards/
Best Practice Tariff but also multiple other areas for example dementia care, continence care and
improvements in nutrition for patients with hip fractures.
This has all been achieved through extensive collaborative work.
Improving care and reducing time to theatre:

Royal Devon and Exeter Hospital
In the last quarter of 2012, 75% of patients from the Exeter Hip Fracture Service at the Royal Devon and
Exeter Hospital had surgery within 36 hours of admission. 25% of patients did not reach theatre within
this time, either due to lack of theatre time (12% of the total) or due to fitness for surgery (12%), which
included patients previously on warfarin awaiting surgery.
82

Since January 2013, an early start initiative for the operative list was implemented in our trauma theatre,
optimizing its utilization from 8:00 every morning and prioritizing hip fracture patients as first cases.
These procedures are performed or supervised by an experienced surgeon whilst the post-take ward
round and meeting normally take place.
In February 2013 a formal audit of compliance to our Trust guidelines for reversal of warfarinisation
was also carried out for this group of patients, aiming towards prompt action as soon as a hip fracture
is diagnosed, identifying correctable delays in the process and leading to shorter reversal periods of
anticoagulation.
These implementations, amongst others, have contributed towards an improvement in the percentage
of patients reaching theatres within 36 hours. The figure for the month of April improved to 93%.
Improving care:
The last 12 months have seen major improvements in outcomes and patient experience. An
Orthopaedics Associate Specialist with a real commitment has taken on a Lead Clinician role as a
champion for patients with hip fracture. Three new morning trauma lists to supplement the previous
five afternoon week-day lists, and extended week-end trauma lists have played an important role in
minimising delays.
Patients are admitted by on-call teams prompt, receive prompt pre-op. optimisation by Trauma
Coordinators, Anaesthetists and the Orthopaedic Specialist, are listed first on dedicated trauma lists with
Consultant Anaesthetists and Senior Surgeons operating or supervising trainees, and transfer to the care
of the multidisciplinary Hip Fracture Service team post-op.
With the support of the Orthogeriatrician the Orthopaedic Specialist carries out robust ward rounds
every day, and monitors the progress of post-op. patients.
As a consequence Pilgrim hospital is achieving BPT for most hip fracture patients, and has seen:
a one day reduction in time-to-theatre from 42.5 hours last year 18.4 hours recently
a four day reduction in the length of stay
a halving of 30 day mortality from 15% to 7.4%
Improving care:
East Lancashire Hospitals NHS Trust
East Lancashire Hospitals NHS Trust has contributed to the NHFD with a high case ascertainment for
past 3 years. Over this time period, there has been the introduction of an integrated care pathway,
fracture neck femur care bundle, a fast tracking system, and a dedicated hip fracture unit in a 46 bed
trauma ward
2 consultant orthogeriatricians provide perioperative care through daily ward rounds (Mon-Fri),
coordinate rehabilitation and discharge through weekly multidisciplinary case conferences, undertake
fall and bone health clinics; and lead the fracture liaison service.
The recent introduction of a clinical group comprising orthopaedic surgeons and orthogeriatricians
(with anaesthetic involvement as required) undertaking joint primary and secondary mortality reviews
allows us to monitor our mortality and morbidity. In addition this group helps share good practice and
lessons to be learnt.
Over the last three years we have consistently improved our Best Practice Tariff standards from 15.62%
in 201011 to 65.33% in 201112 and 73% in 201213. There has been consistent improvement in
five out of six standards year on year for last three years. The platform has identified the main areas for
improvement including length of stay and unexpected variation in mortality which may require further
detailed investigation.
In line with current Department of Health directives, we have improved the ward environment and care
of patients suffering from delirium and dementia; with a designated bay and increased nursing support
for these particularly vulnerable patients.
Improving Care:
The Royal Hampshire County Hospital
The Royal Hampshire County Hospital (Hampshire Hospitals Foundation Trust) started implementation of
an Enhanced Recovery (ER) Pathway for patients with a hip fracture in February 2012.
The #NOF Enhanced Recovery pathway utilises the principles of ER, but key details of the pathway that
support the care and management of patients presenting with a hip fracture are:
GPs summary notes obtained on admission
minimum fasting pre-operatively with administration of pre-op drinks (fast from food for 6 hours,
and clear fluids for 2 hours) Oral intake encouraged as soon as possible post operatively so avoiding
iv fluids where possible
Hb results are obtained within an hour on day 1 to facilitate mobility.
joint therapy working enhancing rehabilitation.
Using these principles for care delivery there has been a reduction in acute length of stay by a day.
Time from admission to surgery has reduced by 6.39 hours to 19.95 hours, and 72% of patients return
to their preadmission residence as against 55% at the start of this work.
Improving Care:
Worthing Hospital
Worthing Hospital treats between 400 and 500 hip fractures annually from an elderly population with
high levels of comorbidity. Data collated by The National Hip Fracture Database (NHFD) and Dr. Foster
in early 2011 identified a higher than expected hospital standardised mortality ratio (HSMR) after hip
fracture.
As a result, the hip fracture pathway was redesigned according to practice recommendations from the
National Institute for Health and Clinical Excellence (NICE) and the British Orthopaedic Association /
British Geriatrics Society Blue book.
84

The effect of practice change on outcomes and quality indicators such as mortality and length of stay
(LOS) after hip fracture was analysed.
Changes to the patient pathway included
admitted under geriatrician to ward specialising in perioperative hip fracture care
pre operative Orthogeriatrician review
prioritised for all day trauma list
on-site rehabilitation
There was a significant drop in mean LOS (from 28 to 21 days) and mean time to surgery (42 to
28 hours) as well as time to orthogeriatric assessment. There was no significant difference in crude
mortality between groups but the HSMR dropped to the expected level. The post intervention group
_ 3.
had significantly higher numbers of patients over the age of 90 and with ASA >
Implementing an effective orthogeriatric pathway at our hospital has resulted in significant
improvements in clinical outcomes and quality indicators despite an increase in the complexity of an
already challenging case mix.
Benchmarking data from national databases such as the NHFD and Dr. Foster may be used to facilitate
improvement in service delivery. However, careful examination of local data is still important to correct
discrepancies, adjust for local case mix and account for the differences in methodology used by these
organisations.
Appendix B Facilities Audit tables
86
Orthogeriatric
consultant
hours/week
Orthogeriatric
middle grades
hours/week
Orthogeriatric
ward rounds
per week
No. of WTE
fragility fracture
nurses
No. of WTE
fracture
liaison nurses
Falls
clinic
DXA
on-site
facility
Data
collected
by
Data
entered
by
Where
rehabilitation
is done
Both
60
14.5
10
32
Con
Axial
Doctors
Admin
Ward
330
DGH
20
Con
Axial
Nurses
Nurses
Ward
No. of WTE
Orthopaedic
middle grades
480
310000
No. of WTE
Orthopaedic
Consultants
No. of hip
fractures
treated/annum
350000
AEI
Hours of
Designated
trauma/week
Trauma
catchment
population
ADD
Trauma
Service
Description
Hospital
Code
Facilities audit 20122013
AIR
220000
270
DGH
20
12
Con
Axial
Doctors
Audit
Ward
ALT
402303
387
DGH
48
None
Axial
Nurses
Admin
GORU
ASH
250000
350
DGH
44
40
Con
None
Nurses
Nurses
GORU
BAR
224600
590
DGH
31.5
13
Con
Axial
Nurses
Audit
GORU
BAS
320000
388
DGH
41
12
11
12
45
1.2
1.4
Con
Axial
Nurses
Nurses
Ward
BAT
500000
550
DGH
15
17
13
40
37.5
Con
Peri
Nurses
Admin
Ward
BED
270000
220
DGH
20
Nurse
Axial
Care Asst
Care Asst
Ward
BFH
400000
468
DGH
46.5
12
10
10
None
Axial
Nurses
Nurses
Ward
BLA
525000
400
DGH
19
16
10
35
Con
Axial
Care Asst
Care Asst
Ward
BNT
500000
308
DGH
32
7.5
16
40
Con
Axial
Nurses
Nurses
Ward
BOL
350000
380
DGH
40
10.5
40
Con
None
Nurses
Nurses
Ward
BRD
480000
365
DGH
36
13
32
None
Axial
Nurses
Nurses
Ward
BRG
95000
95
DGH
33
Con
Axial
Nurses
Nurses
Ward
BRI
300000
400
Both
29
15
12
10
0.74
Con
Axial
Nurses
Nurses
Ward
BRO
307000
380
DGH
48
14
32
Con
Axial
Nurses
Admin
Ward
BRT
300000
278
DGH
44
15
15
Con
Peri
Audit
Audit
Ward
BSL
150000
150
DGH
28
Con
Axial
Nurses
Admin
Ward
7.34
Con
Axial
Audit
Audit
Ward
Con
None
Admin
Admin
Ward
10.5
CCH
350000
30
Both
CGH
200000
318
DGH
24
CHE
360000
390
DGH
31.5
CHG
225000
300
DGH
28
10
14
None
Axial
Admin
Admin
Ward
10.5
9.5
11
30
1.1
Con
Axial
Nurses
Nurses
Ward
CHS
250000
219
DGH
17.5
7.5
12
32
Con
None
Nurses
Nurses
Ward
CLW
240000
365
DGH
56
0.3
None
Peri
Nurses
Nurses
Ward
CMI
200000
250
DGH
29.5
10
Nurse
None
Nurses
Audit
Ward
COC
250000
320
DGH
40
Con
None
Nurses
Nurses
Ward
87
Orthogeriatric
ward rounds
per week
No. of WTE
fragility fracture
nurses
No. of WTE
fracture
liaison nurses
Falls
clinic
DXA
on-site
facility
Data
collected
by
Data
entered
by
52
12
10
Con
Axial
Nurses
Nurses
Ward
DGH
45
20
30
Con
None
Nurses
Admin
GORU
DAR
250000
327
DGH
33.5
15
Con
Axial
Audit
Audit
Ward
DER
500000
570
DGH
84
20
20
12
Con
Axial
Nurses
Admin
Ward
DGE
360000
410
DGH
42
20
Con
None
Nurses
Nurses
Ward
DID
300000
350
DGH
56
12
15
16
Con
Axial
Nurses
Admin
Ward
10
15
Con
Axial
Nurses
Admin
GORU
30
None
Peri
Admin
Admin
Ward
DRY
250000
320
DGH
59
DVH
290000
278
DGH
20
5.5
Where
rehabilitation
is done
Orthogeriatric
middle grades
hours/week
DGH
250
Orthogeriatric
consultant
hours/week
Trauma
Service
Description
550
250000
No. of WTE
Orthopaedic
middle grades
No. of hip
fractures
treated/annum
370000
No. of WTE
Orthopaedic
Consultants
Trauma
catchment
population
COL
CRG
Hours of
Designated
trauma/week
Hospital
Code
EAL
300000
150
DGH
20
12
Con
None
Nurses
Nurses
GORU
EBH
750000
480
DGH
49
11
12
28
12
Con
None
Doctors
Admin
GORU
ENH
500000
480
DGH
28
10
14
12
40
Con
Axial
Nurses
Admin
Ward
ESU
500000
510
DGH
55
34
40
0.27
Con
Axial
Nurses
Nurses
Ward
13
20
Con
Axial
Doctors
Admin
GORU
Con
None
Audit
Audit
Ward
Con
Axial
Nurses
Care Asst
Ward
FAZ
500000
400
DGH
56
FGH
300000
120
DGH
17.5
FRM
450000
330
DGH
76
22
18
40
FRY
500000
420
Both
60
14
12
38
7.5
1.4
Con
Axial
Nurses
Nurses
Ward
GEO
260000
170
Both
68
16
Con
Axial
Nurses
Nurses
GORU
GGH
290000
255
DGH
24
Con
Axial
Nurses
Admin
Ward
GHS
400000
380
DGH
24
11
Con
Axial
Doctors
Admin
Ward
GLO
320000
400
DGH
52.5
16
16
16
Con
Axial
Nurses
Nurses
Ward
GRA
130000
120
DGH
None
None
Doctors
Admin
Ward
GWE
552000
310
DGH
56
15
14
7.5
Con
Axial
Nurses
Nurses
GORU
GWH
486000
269
DGH
48
10
Con
Axial
Nurses
Nurses
Ward
GWY
220000
280
DGH
35
11
10
16
3.25
3.25
Con
Axial
Doctors
Admin
GORU
HAR
200000
260
DGH
20
30
0.5
Con
Axial
Nurses
Admin
Ward
HCH
230000
282
DGH
30
10
0.8
Con
Axial
Nurses
Nurses
GORU
HIL
350000
230
DGH
56
16
14
None
None
Doctors
Audit
Ward
88
Orthogeriatric
middle grades
hours/week
Orthogeriatric
ward rounds
per week
No. of WTE
fragility fracture
nurses
No. of WTE
fracture
liaison nurses
Falls
clinic
DXA
on-site
facility
Data
collected
by
Data
entered
by
Where
rehabilitation
is done
Con
None
Doctors
Nurses
Ward
15
Con
None
Nurses
Nurses
Ward
25
40
0.2
Con
None
Admin
Admin
Ward
250000
200
DGH
17.5
28
115000
80
DGH
200000
175
DGH
Orthogeriatric
consultant
hours/week
No. of WTE
Orthopaedic
middle grades
No. of WTE
Orthopaedic
Consultants
Hours of
Designated
trauma/week
HOR
Trauma
Service
Description
HOM
No. of hip
fractures
treated/annum
HIN
Trauma
catchment
population
Hospital
Code
HRI
650000
500
DGH
77
22
15
20
40
10
Con
Axial
Nurses
Audit
Ward
HUD
452848
503
DGH
52.5
18
13.4
16
Nurse
None
Nurses
Nurses
Ward
IOW
140000
250
Tertiary
17.5
10
Con
Axial
Nurses
Nurses
GORU
IPS
350000
438
DGH
14
20
Con
Axial
Nurses
Nurses
Ward
35
JPH
250000
400
DGH
KCH
200000
120
Tertiary
36
22.5
KGH
280000
300
DGH
32
KMH
400000
360
DGH
38.5
None
None
Nurses
Nurses
Ward
13
18
30
Con
Axial
Nurses
Nurses
Ward
10
Con
Axial
Audit
Audit
Ward
13
10
Con
Axial
Nurses
Nurses
Ward
Ward
KTH
325000
350
DGH
48
40
Con
Axial
Nurses
Nurses
LDH
330000
300
DGH
52
11
11
20
Con
Axial
Nurses
Nurses
Ward
LER
1000000
900
Tertiary
96
20
10
28
Con
Axial
Nurses
Nurses
Ward
LEW
450000
170
DGH
24
0.5
Con
Axial
Doctors
Audit
Ward
LGH
280000
280
DGH
32
8.5
None
Axial
Nurses
Nurses
Ward
LGI
751000
700
Both
136
16
27
32
Con
Axial
Nurses
Audit
Ward
LIN
336000
390
DGH
75
13
11
37.5
None
Peri
Nurses
Nurses
Ward
LON
250000
125
Both
66
16
20
19
Con
Axial
Nurses
Admin
Ward
MAC
220000
250
DGH
28
16
12
None
Axial
Audit
Audit
Ward
MAY
380000
300
DGH
35
20
10
Con
Axial
Doctors
Doctors
Ward
MDW
377250
375
DGH
66
11
10
20
Con
Axial
Nurses
Admin
Ward
MKH
246000
220
DGH
32
10
20
Nurse
Peri
Nurses
Nurses
Ward
MOR
400000
450
Both
60
19
10
15
18.75
None
Axial
Nurses
Audit
GORU
MPH
360000
400
DGH
52
10
12
20
Con
Axial
Nurses
Nurses
GORU
MRI
251665
190
Both
49
10.1
17
1.8
Con
Axial
Nurses
Nurses
Ward
NCR
249500
336
DGH
55.5
15
10
11
1.3
1.3
Con
Axial
Nurses
Nurses
Ward
89
37.5
DXA
on-site
facility
Data
collected
by
Data
entered
by
Where
rehabilitation
is done
16
Falls
clinic
10
No. of WTE
fracture
liaison nurses
No. of WTE
fragility fracture
nurses
Orthogeriatric
ward rounds
per week
20
Orthogeriatric
middle grades
hours/week
DGH
Orthogeriatric
consultant
hours/week
Trauma
Service
Description
250
No. of WTE
Orthopaedic
middle grades
No. of hip
fractures
treated/annum
160000
No. of WTE
Orthopaedic
Consultants
Trauma
catchment
population
NDD
Hours of
Designated
trauma/week
Hospital
Code
None
Axial
Nurses
Nurses
GORU
NEV
200000
300
DGH
29
Con
Axial
Nurses
Nurses
GORU
NGS
500000
620
Both
66.5
25
12
72
40
10
Con
Axial
Nurses
Admin
Ward
NHH
280000
220
DGH
32
10
10
24
Con
Peri
Nurses
Nurses
Ward
NMG
350000
300
DGH
49
12
11
None
None
Nurses
Nurses
Ward
NMH
250000
130
DGH
20
10
10
Con
None
Doctors
Doctors
Ward
NOB
85000
81
DGH
14
None
Axial
Nurses
Audit
GORU
NOR
825000
800
DGH
84
16
NPH
495000
275
DGH
44
NTG
400000
380
DGH
NTH
380000
376
DGH
20
28
0.6
Con
Axial
Audit
Audit
Ward
8.8
40
40
Con
Axial
Admin
Admin
Ward
48.5
15.03
14
20
0.7
0.6
0.6
Con
Axial
Nurses
Admin
Ward
50
11
11
17
Con
Axial
Audit
Audit
Ward
NTY
250000
330
DGH
40
10
32
Con
Axial
Nurses
Nurses
Ward
NUH
360000
375
Tertiary
45
66
0.7
None
Axial
Nurses
Admin
GORU
3.5
Con
Axial
Audit
Audit
Ward
Con
None
Doctors
Admin
Ward
GORU
NUN
300000
240
DGH
28
12
12
NWG
297000
100
DGH
25
OHM
429700
325
DGH
42
OLD
700000
500
Both
104
PAH
299900
350
DGH
32
PCH
200000
220
DGH
17.5
11
11
25
40
Con
Axial
Nurses
Audit
13.75
12
20
20
10
Nurse
Axial
Nurses
Nurses
11
11
30
32
None
None
Audit
Audit
Ward
None
None
Nurses
Nurses
Ward
PEH
65000
74
DGH
Con
Axial
Audit
Audit
GORU
PET
310000
400
DGH
40
16
Con
Axial
Nurses
Nurses
Ward
PGH
490000
899
DGH
139
10
63
16
None
None
Nurses
Audit
Ward
PIL
230000
330
DGH
41
10
10
Con
Axial
Nurses
Admin
Ward
PIN
500000
560
DGH
12
14
22
None
Axial
PLY
450000
481
Both
91.5
21
14
40
40
None
Axial
Nurses
Nurses
GORU
PMS
400000
375
DGH
70
12.83
17.64
28
56
Con
Axial
Doctors
Audit
Ward
POW
160000
300
DGH
24.5
10
Con
Axial
Audit
Audit
Ward
10
Care Asst Care Asst
GORU
90
DGH
28
13
12
320
DGH
45.5
QEQ
350000
400
DGH
37
9.5
QKL
250000
350
DGH
30
1.8
Con
Axial
16
Con
Axial
35.5
Con
Axial
Where
rehabilitation
is done
375
190000
39.5
Data
entered
by
383000
30.5
Data
collected
by
QEB
QEG
DXA
on-site
facility
4.9
Falls
clinic
18.93
No. of WTE
fracture
liaison nurses
No. of WTE
Orthopaedic
middle grades
84
No. of WTE
fragility fracture
nurses
No. of WTE
Orthopaedic
Consultants
DGH
Orthogeriatric
ward rounds
per week
Trauma
Service
Description
688
Orthogeriatric
middle grades
hours/week
No. of hip
fractures
treated/annum
650000
Orthogeriatric
consultant
hours/week
Trauma
catchment
population
QAP
Hours of
Designated
trauma/week
Hospital
Code
Nurses
Audit
Ward
Nurses
Audit
GORU
Nurses
Nurses
Ward
11.5
20
40
1.3
Con
None
Doctors
Admin
Ward
Con
Peri
Nurses
Nurses
Ward
RAD
300000
480
Both
124
8.5
10
40
40
Con
None
Audit
Audit
GORU
RBE
550000
492
DGH
56
18
32
40
0.5
Con
None
Doctors
Doctors
GORU
RCH
400000
555
DGH
84
19
20
20
Con
Axial
Nurses
Nurses
Ward
RDE
396183
510
DGH
56
12
20
10
None
Axial
Nurses
Nurses
Ward
10
RED
320000
250
DGH
20
10
Con
None
Nurses
Nurses
Ward
RFH
250000
210
DGH
20
6.2
20
10
0.5
Con
Axial
Nurses
Doctors
GORU
RGH
280000
275
DGH
17.5
7.5
None
Axial
Nurses
Nurses
GORU
RHC
190000
239
DGH
17.5
24
Con
None
Nurses
Nurses
Ward
RLI
300000
266
DGH
38
10
12
12
Con
Axial
Audit
Audit
Ward
RLU
350000
360
Both
100
25
14
27
Con
Axial
Nurses
Audit
Ward
ROT
254000
300
DGH
36
12.2
Con
None
Nurses
Nurses
Ward
RPH
400000
430
Both
56
12
13
12
Con
None
Nurses
Nurses
Ward
RSC
650000
570
Tertiary
115
26
11
28
160
Nurse
Axial
Audit
Audit
Ward
RSS
330000
350
DGH
50
10
Con
None
Nurses
Nurses
GORU
RSU
320000
357
DGH
36
13
11
20
45
Con
Axial
Nurses
Nurses
Ward
RUS
500000
500
DGH
56
11
10
16
56
3.8
Con
Axial
Nurses
Nurses
Ward
RVB
1020000
924
Both
126.9
12.93
16
30
30
Con
None
Audit
Audit
GORU
RVN
300000
450
Both
70
7.5
12
10
1.16
1.14
Con
Axial
Nurses
Admin
GORU
SAL
225000
250
DGH
30
19
35
Con
Peri
Nurses
Admin
Ward
SAN
550000
360
DGH
72
11.5
15
10
1.5
Con
Axial
Nurses
Audit
Ward
SCA
230000
267
DGH
21
15
Con
Axial
Nurses
Audit
Ward
SCM
392000
512
DGH
65
22
16
37.5
None
Axial
Admin
Admin
GORU
91
SHC
350000
440
DGH
SHH
377000
362
DGH
3.5
Con
Axial
Nurses
Admin
Ward
Con
Peri
Nurses
Admin
Ward
0.5
Where
rehabilitation
is done
112
Data
entered
by
32
Both
6
10
Data
collected
by
DGH
625
DXA
on-site
facility
485
500000
Falls
clinic
361000
SGH
No. of WTE
fracture
liaison nurses
SEH.
No. of WTE
fragility fracture
nurses
24.5
Orthogeriatric
ward rounds
per week
32
DGH
Orthogeriatric
middle grades
hours/week
DGH
230
Orthogeriatric
consultant
hours/week
Trauma
Service
Description
224
340000
No. of WTE
Orthopaedic
middle grades
No. of hip
fractures
treated/annum
230000
No. of WTE
Orthopaedic
Consultants
Trauma
catchment
population
SCU
SDG
Hours of
Designated
trauma/week
Hospital
Code
15.27
11
0.2
Con
Axial
Nurses
Admin
Ward
20
10
24
40
Con
Axial
Nurses
Admin
Ward
62.5
16
12
26
26
None
None
Nurses
Audit
Ward
59.5
17
10
18
Con
Axial
Nurses
Audit
Ward
SLF
275500
220
Both
61
14
11
20
0.5
0.5
Con
Axial
Doctors
Doctors
GORU
SMV
500000
380
DGH
49
15
12
20
Con
None
Nurses
Nurses
GORU
SOU
224000
263
DGH
144
Ward
SPH
450000
410
DGH
45
STD
156000
222
DGH
17.5
8
12.61
5
Nurse
Axial
Nurses
Nurses
13
18
Con
Axial
Nurses
Nurses
Ward
Con
Axial
Nurses
Nurses
GORU
STH
400000
210
Tertiary
44
14
Con
Axial
Doctors
Admin
Ward
STM
325000
300
Both
76
9.31
7.34
32
32
Con
Axial
Audit
Audit
Ward
STO
575000
550
Tertiary
60
19
16
15
Nurse
Axial
Nurses
Nurses
GORU
STR
250000
350
DGH
40
12
10
Con
Axial
Nurses
Care Asst
Ward
SUN
375000
420
DGH
52.5
14
1.85
Con
Peri
Nurses
Nurses
Ward
TGA
250000
350
DGH
53
Con
Axial
Nurses
Nurses
Ward
TLF
240000
225
DGH
17.5
TOR
270000
460
DGH
53.5
12
TRA
200000
110
DGH
20
TUN
500000
460
Both
70
14
Nurse
Peri
Doctors
Admin
GORU
20
40
Con
Axial
Doctors
Nurses
Ward
Con
None
Nurses
Nurses
Ward
13
Con
Axial
Audit
Audit
GORU
7.5
UCL
198000
130
Both
24
11
None
Axial
Nurses
Admin
GORU
UHC
850000
518
Both
108
26
16
10
None
Axial
Nurses
Audit
Ward
UHN
750000
830
Both
129
12
16
25
25
1.2
1.2
Con
Axial
Audit
Audit
Ward
UHW
500000
500
Both
92
14
15
30
27
None
Axial
Nurses
Nurses
Ward
VIC
330000
480
DGH
55.5
14
0.2
Nurse
Peri
Nurses
Admin
GORU
WAR
270000
365
DGH
30
20
40
6.24
Con
Axial
Nurses
Nurses
Ward
92
20
50
Con
None
Where
rehabilitation
is done
15
Data
entered
by
68
10
Data
collected
by
17.5
DGH
DXA
on-site
facility
DGH
330
Falls
clinic
150
450000
No. of WTE
fracture
liaison nurses
165500
No. of WTE
fragility fracture
nurses
WCI
WDG
Orthogeriatric
ward rounds
per week
60
Orthogeriatric
middle grades
hours/week
DGH
Orthogeriatric
consultant
hours/week
Trauma
Service
Description
450
No. of WTE
Orthopaedic
middle grades
No. of hip
fractures
treated/annum
500000
No. of WTE
Orthopaedic
Consultants
Trauma
catchment
population
WAT
Hours of
Designated
trauma/week
Hospital
Code
Doctors
Doctors
GORU
None
Axial
Nurses
Audit
Ward
10
Con
Peri
Nurses
Nurses
Ward
WDH
210000
255
DGH
28
None
Axial
Nurses
Admin
Ward
WES
180000
160
DGH
26
Con
Axial
Nurses
Nurses
Ward
WEX
550000
330
DGH
48
10
12
37.5
WGH
200000
400
DGH
0.6
0.6
Con
None
Nurses
Admin
GORU
Nurse
Axial
Audit
Audit
Ward
WHC
315000
320
DGH
40
10
Con
None
Nurses
Nurses
Ward
WHH
175000
385
DGH
45
12
12
10
40
Con
None
Audit
Audit
GORU
WHI
350000
406
DGH
56
10
16
Con
Axial
Doctors
Audit
Ward
WHT
240000
140
DGH
20
Con
Axial
Doctors
Nurses
Ward
WIR
400000
461
DGH
81
14
10
20
20
Con
Axial
Audit
Audit
GORU
WMH
260000
365
DGH
24
12
Nurse
None
Nurses
Admin
Ward
WMU
254000
220
DGH
30
Con
Peri
Nurses
Audit
Ward
WRC
340000
425
DGH
10
Con
Axial
Nurses
Nurses
GORU
WRG
300000
435
DGH
43.5
16
Con
None
Nurses
Nurses
Ward
WRX
250000
235
DGH
27
10
12
Con
None
Nurses
Nurses
GORU
WSH
280000
324
DGH
17.5
10
20
Con
None
Nurses
Audit
Ward
WWG
180767
300
DGH
28
10
None
None
Nurses
Audit
GORU
WYB
135000
180
DGH
None
None
Nurses
Admin
Ward
WYT
540000
274
Both
49
12
10
30
Con
Peri
Nurses
Nurses
Ward
YDH
350000
400
DGH
37
10
10
20
Con
None
Audit
Audit
Ward
YEO
180000
250
DGH
36
30
0.5
None
Axial
Nurses
Admin
Ward
37.5

Further appendices
The following further appendices are available as a separate document available from nhfd.co.uk (Other
resources NHFD NHFD Reports and Publications National Reports)
Appendix C Structure and Governance
Appendix D Classification Trees
Appendix E Outlier management
Appendix F Mortality analysis methods
Appendix G Trend analysis methods
Appendix H NHFD chart outlines
Acknowledgements
NHFD participants: clinical and audit staff in all contributing hospitals
British Geriatrics Society
British Orthopaedic Association
Royal College of Physicians
Royal College of Surgeons of England
Health and Social Care Information Centre
Department of Health
National Clinical Audit Advisory Group
Healthcare Quality Improvement Partnership
Quantics Consulting Ltd
94
National Hip
National
HipDatabase
Fracture Database
Fracture
National
report
National
report
20132013
Summary
Need to know more?
Contact:
NHFD Headquarters:
Royal College of Physicians,
11 St Andrews Place
Regents Park
London
NW1 4LE
Tel: 020 7251 8868
Project manager Chris Boulton
Email: christopher.boulton@rcplondon.ac.uk
Tel: 020 3075 1511
Project coordinator Andy Williams
Email: andy@nhfd.co.uk
Tel: 07818 065915
Project coordinator Fay Plant
Email: fay@nhfd.co.uk
Tel: 07792 213369

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National Hip Fracture Database

National Hip Fracture Database

This report was prepared by the members of the workstream

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

Copyright National Hip Fracture Database 2013. All rights reserved.3

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

Copyright National Hip Fracture Database 2013. All rights reserved.5

The National Hip Fracture Database

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

The 2013 National Report

Copyright National Hip Fracture Database 2013. All rights reserved.7

1. Admission to orthopaedic ward within 4 hours

2. Surgery within 48 hours and during working hours

3. Patients developing pressure ulcers

4. Pre-operative assessment by an orthogeriatrician

5. Discharged on bone protection medication

6. Received a falls assessment prior to discharge

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

Copyright National Hip Fracture Database 2013. All rights reserved.9

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

Future development of the NHFD

Copyright National Hip Fracture Database 2013. All rights reserved.11

Improving description of care

The NHFD and Anaesthetic Management

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

The NHFD and NICE Quality Standard 16

Copyright National Hip Fracture Database 2013. All rights reserved.13

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

The NHFD and Clinical Commissioning Groups

Copyright National Hip Fracture Database 2013. All rights reserved.15

George Eliot Hospital, Nuneaton

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

St Helier Hospital, Carshalton

Copyright National Hip Fracture Database 2013. All rights reserved.17

Chart 1 Completeness of data fields on cases included in the

Total number of fields

Copyright National Hip Fracture Database 2013. All rights reserved.

National Hip Fracture Database

Copyright National Hip Fracture Database 2013. All rights reserved.19

Chart 2 Admitted from

Last year this chart was

In this report we have

Already in hospital (4.1%)

Acute hospital (0.4%)

Rehabilitation unit (0.8%)

Already in hospital (4.1%)

Nursing care (7.4%)

Residential care (11.8%)

There is some variation in

Copyright National Hip Fracture Database 2013. All rights PLY

National Hip Fracture Database

Chart 3a Pre-operative AMT Score

The AMT Score is a simple

Only 87.8% (range 0% to

Of the known admission

Copyright National Hip Fracture Database 2013. All rights reserved.3

Copyright National Hip Fracture Database 2013. All rights reserved.5

Copyright National Hip Fracture Database 2013. All rights reserved.7

Copyright National Hip Fracture Database 2013. All rights reserved.9

Copyright National Hip Fracture Database 2013. All rights reserved.11

Copyright National Hip Fracture Database 2013. All rights reserved.13

Copyright National Hip Fracture Database 2013. All rights reserved.15

Copyright National Hip Fracture Database 2013. All rights reserved.17

Copyright National Hip Fracture Database 2013. All rights reserved.19

Copyright National Hip Fracture Database 2013. All rights reserved.21

Copyright National Hip Fracture Database 2013. All rights reserved.25

Copyright National Hip Fracture Database 2013. All rights reserved.27

Copyright National Hip Fracture Database 2013. All rights reserved.29

Copyright National Hip Fracture Database 2013. All rights reserved.31

Copyright National Hip Fracture Database 2013. All rights reserved.33

Copyright National Hip Fracture Database 2013. All rights reserved.35