Western Isles Hospital awarded ‘Most Improved Hospital’ for Hip Fracture Care

Western Isles Hospital has been presented with a Hip Fracture Care Awardfor Most Improved Hospital in Scotland against the Hip Fracture Standards of Care. 

Hip Fracture patients are amongst the frailest and most vulnerable of all emergency hospital admissions.  By adhering to best practice standards of care, the quality of life of those patients can be significantly improved.  

The Scottish Hip Fracture Audit measures performance of hospitals against a set of published standards with the aim of providing the best possible outcomes to patients.  

At the 2021 (online) Annual Scottish National Hip Fracture Conference, the team at Western Isles Hospital was delighted to win the award for Most Improved Hospital in Scotland against the Hip Fracture Standards of Care. 

Improvements in the past year have focussed on several key measures, including reducing the time from admission to surgical repair of a fracture; providing a comprehensive geriatric assessment within 3 days of admission to hospital; reducing patients’ length of stay in hospital; and introducing bone health assessments for hospital inpatients.  

Time from Admission to Surgical Repair of Fracture 

Evidence shows poorer outcomes for patients where there are delays between admission to hospital and fracture fixation. Repairing hip fractures early reduces the pain and suffering of patients and gets them mobilising as quickly as possible, which in turn reduces the risk of complications such as infections and blood clots. The majority of Western Isles Hospital patients now have surgical fixation of hip fracture within the target time of 36 hours from admission. 

Comprehensive Geriatric Assessment 

Patients with hip fractures tend to be elderly and frequently have multiple long term health conditions at the time of injury. They are also frail with an increased risk of falling. Comprehensive Geriatric Assessment facilitates high-quality care by taking account of all co-existing conditions of patients and the complexity of medications they may be taking. In Western Isles Hospital, our Consultant Physicians have now taken on the role of providing comprehensive geriatric assessment within 3 days of admission to hospital. 

Total Length of Hospital Stay 

Patients tell us that above all else they want to be able to leave hospital and to be at home in their own surroundings and with their families. We endeavour to achieve this for our patients, firstly by repairing their fracture and mobilising them quickly, but also by providing care for the transition from hospital to home. We have reduced the total length of hospital stay for most of our hip fracture patients with the help of our START team who provide short term rehabilitation input with our patients for several weeks after returning home and our Hospital at Home team who provide medication input, dressings changes and medical review as necessary in patients’ own homes. 

Bone Health assessments 

Hip fractures are fragility fractures often caused by underlying low bone mineral density or osteoporosis. Evidence shows that the risk of further fracture is dramatically increased following a hip fracture with more than doubling of risk of a second hip fracture. Since the Western Isles Fracture Liaison Service commenced in late 2019, all of our hip fracture patients have a bone health assessment during their orthopaedic hospital stay and treatment where appropriate to reduce the risk of further fractures. 

Hip fracture care involves a huge number of healthcare staff across a wide range of different specialties, and achievement of the standards of care relies on all of them. 

Orthopaedic Surgeons and Anaesthetists provide surgical management and pain control whilst Physicians take care of complex medical issues. Nursing teams from the Emergency Department, Wards and Theatres provide ongoing care that is tailored to patient needs at every stage of their journey. Radiographers provide imaging in the diagnosis, repair and post-operative checking of fractures. Physiotherapists work on patient mobility from the earliest post operative opportunity, whilst Occupational Therapists help patients to regain independence with activities of daily living. Nutritional support is provided by Dieticians, and Dentists visit the patients in hospital to ensure that their teeth and gums are healthy, both to aid nutrition and to reduce risks of some medications. Pharmacists manage complex medication requirements of frail patients, whilst the Laboratory staff run diagnostic and monitoring tests. Supported discharge from hospital is reliant on General Practice staff, Re-enablement workers and often Social Care staff. 

NHS Western Isles Chief Executive, Gordon Jamieson, said: “NHS Western Isles staff should be proud of their achievement in winning this award, especially against the backdrop of the most challenging two years for healthcare services. 

“This is a huge team effort and an outstanding achievement for all involved, which most importantly demonstrates a significantly improved and high quality service for our patients.”