22 December 2008
Some of the most frail and elderly patients in UK hospitals face early death and permanent disability because of delays in treating emergency hip fractures as hospitals come under pressure to meet NHS elective targets. These are the findings of a survey of senior orthopaedic surgeons undertaken by the British Orthopaedic Association.
‘Neck of femur’ fractures are one of the most common complex trauma problems orthopaedic surgeons face with 70,000 cases a year and this number is rising year on year. This kind of fracture almost always occur in very elderly people following falls and requires urgent treatment to reduce pain, restore mobility and prevent disability or death. The British Orthopaedic Association recommends surgery within a maximum of 48 hours of the patient being fit for surgery and believes 95 per cent of cases should be treated within this time limit. At present mortality rates for these patients run at ten per cent within a month and 30 per cent within a year of their fracture.
The study found:
-More than half of surgeons stated their unit could not manage to operate on 95 per cent of these patients within 48 hours. They estimate that approximately one fifth of these patients have to wait more than 48 hours.
-Lack of specialised geriatric medical support to get patients fit for surgery, low commitment from NHS management and shortages of dedicated theatre time for trauma were cited as main causes.
-The surgeons stated a range of severe consequences of failing to operate on these patients within 48 hours including increased morbidity (91 per cent), increased length of stay (91 per cent) and poor rehabilitation (86 per cent). Where delay was significantly in excess of 48hours 80 per cent of respondents indicated that this increased the risk of the patient dying.
-More than half said their hospital refused cancel elective surgery lists to treat emergency trauma patients – stating that in those Trusts the pressure to meet waiting list targets was prioritised over the care of those needing urgent care. More than 40 per cent of respondents believed trauma care is worse since the 18 week target was introduced.
-Less than 20 per cent of respondents said their unit met the BOA standards for hip fracture care*.
Clare Marx, President of the BOA said: “The system is letting down our oldest and frailest patients in too many hospitals. These patients come to hospital in extreme pain and distress, they often have other long-term medical conditions and may be confused or have dementia. They are a group who are complicated to manage clinically and are not at present an NHS management priority. I believe if we get care right for this group of patients then we would get it right for everyone else who comes to hospital. Treating them efficiently and with dignity would even save money.”
John Black, President of the Royal College of Surgeons, added: “It cannot be right for emergency patients in great pain and in need of swift treatment to have to wait. The NHS should allow surgeons the flexibility to treat these patients as a priority offering a proper service to this large and ever increasing group of patients.”
*Full details of the BOA standards for care of trauma patients with hip fractures are laid out in the "British Orthopaedic Association Standards for Trauma (BOAST): Hip Fracture in the Elderly Person" and "The Care of Patients with Fragility Fractures (“Blue book”)":
Copies of the full survey result are available from the RCS press office.
Notes to Editors
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