No drop in quality of care for hip fracture patients despite Covid-19 – report

The quality of care given to thousands of patients who fractured their hip last year was maintained despite the challenges posed by the Covid-19 pandemic, a new report indicates.

Despite the pandemic, many areas saw improvements in performance, according to the annual report of the Irish Hip Fracture Database.

Hip fractures are the most common injury suffered by older people and, in the vast majority of cases, early surgery is the best and safest way to treat patients.

One-third of patients were admitted to an orthopaedic ward within four hours, up from 25 per cent in 2019.

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More patients received a specialist falls assessment than in 2019; this figure has improved each year, from 47 per cent in 2017 to 85 per cent in 2020.

The proportion of patients receiving surgery within 48 hours, the incidence of pressure ulcers and the number seen by a geriatrician all remain unchanged compared to pre-pandemic 2019.

There was a slight fall-off in the percentage of patients receiving a bone density assessment, from 94 per cent in 2019 to 91 per cent in 2020. Some 83 per cent of patients received a specialist falls assessment, down from 85 per cent.

Overall, hip fracture admissions remained high in 2020, aside from a brief drop at the start of the pandemic.

There was a big increase in mortality among hip fracture patients diagnosed with Covid-19. In 2019, 5 per cent of these patients died, but last year 28 per cent of patients who also had the virus died. Patients with Covid as well as a hip fracture also tended to spend much longer in hospital.

Among the 25 per cent of hip fracture patients who had to wait more than two days for surgery, the most common reasons were that their case was awaiting review, or that they were waiting on operating theatre space.

Discharged

Some 28 per cent of patients were discharged home from the hospital, an improvement of four percentage points over 2019.

HSE chief clinical officer Dr Colm Henry said the audit demonstrated continued improvement in the quality of hip fracture care.

“Particular gains [were made] in the areas of bypass whereby 94 per cent of patients are brought directly to the operating hospital, only a few short years after we were bringing patients directly to hospitals with no orthopaedic facility,” he said.

Patients with hip fractures admitted to hospital continued to receive good care during 2020, according to patient representative Bibiana Savin of Sage Advocacy.

Covid-19 does not appear to have had a hugely detrimental effect on the standards of care in acute hospitals in Ireland, she noted, though additional challenges resulted from transfers between hospitals and nursing homes, visiting restrictions and limited rehabilitation supports.