IHFD National Report 2018 Key Findings

Findings
Overall data coverage of 99% was achieved for 2018, with 10 hospitals achieving 100% data coverage.
In 2018, 17% of patients were admitted to an orthopaedic ward or theatre from the ED within four hours, compared with only 11% of patients in 2017. Although improvements have been made, further progress is required.
In 2018, 72% of surgeries were conducted within 48 hours and within normal working hours. This has improved slightly since 2017.
In 2018, 3% of hip fracture patients developed a pressure ulcer after admission to hospital. This has remained unchanged since 2017.
A geriatrician reviewed more than two-thirds (69%) of patients at some point during their acute hospital stay in 2018. This represents a considerable improvement over 2017, when only 50% of patients were reviewed by a geriatrician.
In 2018, a bone health assessment was carried out on 84% of patients nationally (compared with 73% in 2017). Eleven of the participating hospitals achieved in excess of 90% compliance with this standard in 2018.
Prior to discharge, 70% of patients nationally had a specialist falls assessment in 2018 compared with only 47% in 2017. This marks a significant improvement in the past year.
Although improvements have been made nationally with regard to the IHFS, there continues to be variability in the level of service being provided in the 16 participating hospitals.
In 2018, the BPT was introduced, with hospitals receiving a total of €278,000; this represents 7% of hip fracture patients meeting all eight BPT measures. Sligo University Hospital demonstrated the best performance, with 25% of its patients meeting the BPT measures.
Of the 3,751 hip fracture cases recorded in 2018, 69% were female (n=2586).
The home continues to be the place from which patients are most likely to be admitted (83%, n=3115).
Only 40% (n=171) of patients aged 60–69 years were assigned KEY FINDINGS an American Society of Anesthesiologists (ASA) Grade of 3 or 4, compared with almost three-quarters (n=381) of patients aged 90 or over, indicating that as age increases, so does medical morbidity.
The most common types of fractures recorded in 2018 were intracapsular (displaced) fractures (38%, n=1408) and intertrochanteric fractures (35%, n=1330).
Ninety-two percent (n=3468) of patients presented directly to an ED in an operating hospital.
Over one-quarter (n=898) of patients received surgery more than 48 hours after their admission to hospital. The recording of the reason for delay in performing surgery needs to be improved.
Forty-two percent (n=1489) of patients received their surgery within 24 hours of admission to hospital.
Seventy-two percent (n=1312) of arthroplasties reported in 2018 were cemented. However, a large proportion of patients received uncemented implants in several hospitals.
There continues to be a low rate of total hip replacements (THRs) performed in Ireland (4%) compared with other international hip fracture registers. The number of orthopaedic surgeons with arthroplasty surgery skills should be examined at a hospital level, and theatre rosters should be planned to maximise the availability of that skill set for patients.
Eighteen percent of patients did not receive a physiotherapy assessment on the first postoperative day. Hospitals not achieving this standard must review their physiotherapy services in order to enable this assessment to take place on the first postoperative day for all hip fracture patients.
One in five patients (n=735) were discharged directly home from hospital; a further 31% (n=1168) required rehabilitation either at an on-site or off-site facility. Six percent (n=214) of patients were recorded as new admissions to a nursing home or long-stay care facility following discharge.
The mean and median lengths of stay for hip fracture patients were 18.7 and 12 days, respectively, a reduction of approximately 900 acute bed days from 2017.