Remarkable improvements in care for hip fracture patients at Cardiff and Vale University Health Board
For many people, especially older, frail individuals, a hip fracture is a life changing event that can result in prolonged hospitalization and huge loss of independence. Research shows that early remedial surgery and mobilisation can give these patients the best chance of recovery.
Over the last year, Cardiff and Vale University Health Board’s Trauma and Orthopaedic colleagues have implemented radical changes in their treatment pathways, resulting in a quicker and more effective service for hip fracture patients.
The Rapid Hip Fracture Pathway has been implemented over the last year and has resulted in significant improvements in all aspects of the patients’ journey. Cardiff and Vale University Health Board are now one of the best performing hip fracture units in the UK. The team is exceeding the national average for the time it takes to get admitted to the specialist orthopaedic ward and the time it takes to receive an operation. This means that patients can start their rehabilitation process sooner, giving them a better chance to return to pre-injury function and usual place of residence.
In August 2023, 18% of patients presenting at University Hospital of Wales with a hip fracture secured a bed on the Trauma and Orthopaedic ward within four hours but now this has increased to 40%. According to the National Hip Fracture Database, the national average is 9%.
The new pathway is a result of collaborative working between various teams, including the Emergency Unit, Radiology, Trauma and Orthopaedics, Orthogeriatrics and the Welsh Ambulance Service, with full support and engagement from colleagues across the health board.
“The pathway has been a huge team effort” comments Khitish Mohanty, Clinical Director for Orthopaedic Trauma and a Consultant Orthopaedic Surgeon at University Hospital of Wales.
“It has seen a significant improvement in our performance objectives, which we continue to deliver month by month with better care for our elderly, vulnerable patients. It’s an active service, and we are constantly improving our processes through a thorough reviewing system.”
As part of the new pathway, an Emergency Physician in Charge prioritises the quick assessment of hip fractures on presentation at the Emergency Unit, and physicians aim to officially diagnose a hip fracture within 2 hours of presentation at hospital.
Beds on the Trauma and Orthopaedic Ward are ringfenced specifically for hip fracture cases and patients are consistently moved to University Hospital Llandough’s Rehabilitation Ward within 48 hours of surgery. Senior nursing colleagues are responsible for maintaining this constant flow.
One of Mr Mohanty’s patients, 78-year-old Carol Rees, broke her hip at the end of September after tripping over at home. Carol was brought into the Emergency Unit in the early hours of Wednesday 25th September and was operated on that same day.
“Everyone at the University Hospital of Wales and University Hospital of Llandough were wonderful, they were lovely to me and so supportive,” she recalls. Carol was discharged from Llandough’s rehabilitation ward on Friday 11th October, and said her recovery has been “so far, so good”.
Carol is looking forward to being back on her feet, and is being cared for by friends, family and carers.
The Rapid Hip Fracture Pathway has ensured that patients like Carol have a significantly better chance of making a full recovery and maintaining their independence.