A new report focusing on hip fracture care in NSW reveals a marked variation in patient mortality between public hospitals across NSW.
The report reveals that certain NSW hospitals have a mortality rate almost four times higher than other hospitals across the state.
The report, produced by Associate Professor Jacqueline Close and colleagues from Neuroscience Research Australia (NeuRA) in partnership with the NSW Agency for Clinical Innovation, provides data to suggest that the way in which we organise and provide care for some of the most frail members of our society has a marked impact on outcome.
Assoc Prof Close says: ​“We need to develop a better understanding as to why this variation exists. It suggests that some deaths may potentially be avoidable. When we compare hospitals that involve geriatric medicine services in looking after these people against those hospitals without an organized orthogeriatric service, we see that hospitals that have orthopaedic surgeons and geriatricians working together have a significantly lower mortality rate at 30 days after hip fracture surgery.”
The data supports the findings from a previous report from the Clinical Excellence Commission in NSW which highlighted a number of areas where care could be improved for hip fracture patients.
According to data from the Agency for Clinical Innovation, providing acute care for hip fracture patients cost the NSW public hospital system an estimated $98 million in 2009-10. A significant proportion of the cost relates to delays in surgery and managing complications.
​“A number of these conditions and complications are potentially avoidable and if this could be achieved it would lead to a better outcome for patients. The reality is good quality care costs less. It’s a win/​win situation.”
The variation in mortality for hip fracture care has become a focus of activity for the NSW Agency for Clinical Innovation which is about to release seven new standards for care for hip fracture in NSW.
​“The new standards of care, which will apply to all public hospitals in NSW, provide a real opportunity for us to enhance the care of this population which in turn will lead to better outcomes.”
Assoc Prof Close, who also co-chairs The National Australian/​New Zealand Hip Fracture Steering Group, says that the provision of credible data has the potential to drive change in the health system. The Australian and New Zealand Hip Fracture Registry Group is currently developing a national registry for hip fractures in addition to developing a guideline for hip fracture care. The guideline is currently out for public consultation.