THREE-QUARTERS OF hip fracture patients received surgery within 48 hours of admission last year.

It’s one of a number of improvements highlighted in the Irish Hip Fracture Database National Report which was published today by the National Office of Clinical Audit.

Professor Deborah McNamara, President of the Royal College of Surgeons in Ireland (RCSI), said this is a “noteworthy” achievement, “especially in a patient population that is increasingly complex and co-morbid”.

Last year, surgery was carried out on 97% of the 3,845 hip fracture patients across the 16 hospitals surveyed for the report.

Some 75% of those surgeries were carried out within 48 hours and within working hours – a slight increase on 2022’s figure of 74%.

The median time to surgery was 26.9 hours and hospital compliance with the 48-hour standard ranged from 64%-90%.

However, the audit expressed concern with the variance in individual hospital performance.

For example, while 90% of patients received surgery within 48 hours in St Vincent’s Hospital, this figure was 64% in Letterkenny University Hospital.

Another improvement was in the timely admission of patients, with 29% of patients admitted to an orthopaedic ward or taken to theatre within four hours of presenting at the ED, up from 21% in 2022.

Compliance with this standard ranged from 3% in Galway University Hospital to 62% in St James’s Hospital.

The report said it was “encouraging” that over half of the hospitals exceeded the national average and noted that this standard “has long been a challenge for our hospitals” and pointed to “emerging pathways through the EDs that are facilitating a better throughput of hip fracture patients”.

Meanwhile, 87% of patients were mobilised by a physiotherapist on the day of surgery or the day after.

The term “mobilisation” means that, at a minimum, the patient has stood out of bed.

Reasons for not mobilising patients included the patient not being medically fit enough, which accounted for 40% of such instances.

Other reasons for not mobilising included physio staffing issues, in 9% of cases, or the pain being too great, as was the case in 4% of instances where mobilisation on the day or day after surgery did not occur.

Elsewhere, 83% of patients were reviewed by a geriatrician or advanced nurse practitioner during their hospital stay, ensuring tailored care for older adults, a 3% increase on 2022 figures.

In addition, 25% of patients were seen pre-operatively by a geriatrician and 71% received a nutritional risk assessment during their admission in 2023, an increase of 6% from 2022.

However, the report noted as a concern the occurrence of a patient developing a pressure ulcer during their inpatient stay.

The figure last year was 4%, which is up on the 3% figure in 2022 and thus “indicates an area where care protocols could be strengthened to prevent complications after hip fracture surgery”.

Pressure ulcers are more commonly known as bed sores, and 12% of hip fracture patients at Galway University Hospital developed a new ulcer during admission, with this figure ranging from 1%-6% in other hospitals.

This was one of two standards that dropped by 1% last year when compared to 2022, the other being in bone health assessment figures – 88% of patients had a bone health assessment.

Professor Tara Coughlan commended the efforts of healthcare professionals across the 16 participating hospitals and said that the latest report “confirms that the collaborative efforts of dedicated healthcare professionals continue to drive better outcomes for our patients through audit and quality improvement”.