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The BGS has established an exciting new collaboration with the British Orthopaedic Association, with the shared aim of improving the clinical care of patients with fragility fractures and promoting effective secondary prevention to reduce future falls and fractures.

Central to the strategy are the two key initiatives, the Blue Book on the Care of Patients with Fragility Fractures and the National Hip Fracture Database, which were jointly launched with widespread TV, radio and press coverage on September 19th.

Blue Book
The second edition, totally rewritten and updated, replaces a first edition published several years ago and is now an authoritative evidence-based clinical practice guide for the multidisciplinary team, and includes a set of six specific clinical practice standards. Geriatricians Opinder Sahota, Antony Johansen and Colin Currie contributed greatly to the Blue Book’s multidisciplinary writing group, with Colin Currie as its editor. It can be downloaded as a pdf file from the BGS website.

Sponsored by the BOA and BGS, it has also been endorsed by the Age Anaesthesia Association, the National Osteoporosis Society, the Faculty of Public Health, the RCN, the Society for Endocrinology, the Forum of the Royal Colleges of Surgeons and the Specialist Surgical Associations of Great Britain and Ireland - a vital demonstration of multidisciplinary commitment to improving hip fracture care. The Blue Book thus offers a foundation for joint training and clinical governance activities that can build on the success of two BGS/BOA national joint “Instructional Courses” for trainees and consultants held in 2006 and 2007, with a third now planned for 2008

National Hip Fracture Database
The National Hip Fracture Database (NHFD) is a joint BOA-BGS venture and is entirely complementary to the Blue Book. It has involved the creation of an ongoing web-based database of key casemix, process and outcome indicators to monitor and improve the clinical care of hip fracture patients by enabling units to measure the care they provide against the six standards set out in the Blue Book It has been developed from several existing audits, including the Scottish Hip Fracture Audit, which has been established for several years and has now galvanised the Scottish government into setting explicit standards for time to surgery. Trauma surgeon Professor Dave Marsh, at UCL, has been a key driving force and chairs the multidisciplinary NHFD Executive Group, with Colin Currie and orthopaedic surgeon Rob Wakeman providing the ongoing essential clinical leadership. Acknowledgement is also due to previous BGS Falls and Bone Health Section leaders Jacqui Close and Marion McMurdo who helped get this all started.

£300K funding was secured, in the form of generous donations from pharmaceutical and implant companies via ABPI and ABHI, to finance the start-up of NHFD. Its day to day running is in the hands of a clinical and administrative Core Group, and offices are now established at the BGS, with the NHS Information Centre providing expert IT input and technical support that builds on the highly successful MINAP audit project for myocardial infarction.

Over the winter, the existing databases from local audits will be harmonised so that they provide direct input to the central system, and gradually other services are joining up. From Spring 2008 reports will be produced quarterly to support and monitor local service improvement. If you are interested in becoming involved in NHFD, talk to your local orthopaedic trauma service and join up. The project is also linked to a users’ network.

Underpinning all this work is a Memorandum of Understanding between BGS and BOA, setting out our joint intentions and the governance arrangements for the NHFD. We look forward to strengthening and broadening this alliance to reflect the wide multidisciplinary nature of the work, and thus to improving the care of this important injury.

Finbarr C Martin
Chair
Falls and Bone Health Section of the BGS

Press release:

PRESS NOTICE- NHS wasting £millions on poor quality care for hip fractures

The NHS is failing to deal with the spiralling costs and human misery caused by hip fractures by routinely failing to identify and treat osteoporosis in patients who have already suffered a previous fracture, and by not addressing the UK-wide post code lottery that exists in fracture care.

Currently, 75,000 hip fractures a year in the UK cost the NHS £1.4bn, with numbers set to double by 2050. Between a half and two thirds of these patients have suffered a prior fracture which could, and should, have served as a warning that patients were at risk of further fractures. Preventative treatment is available, but most patients miss out.

A recent UK audit found that fewer than 5% of women with a history of fracture have undergone a DXA scan - a simple test to measure bone density – and less than 10% were receiving bone protection drugs which can reduce fracture incidence by half.

Doctors want all fracture patients over the age of 50 to be routinely tested for the presence of osteoporosis. The condition, which causes a loss of mineral density in the bone, is particularly prevalent in women, with 50% of over 50s likely to suffer a related fracture.

In a major initiative to reduce the risk of future fractures and improve hip fracture care, clinicians from the British Orthopaedic Association and the British Geriatrics Society today launch a guide to best practice, the Blue Book on the Care of Patients with Fragility Fractures, and a new audit of hip fracture care and fracture prevention, the National Hip Fracture Database, which will monitor care standards.

Standards in hip fracture care vary widely, and there is huge scope to improve. Prompt surgery followed by good medical care and rehabilitation promotes early recovery and reduces hospital stay. But delays - which cause pain and distress, and slow up recovery - are common and must be addressed. The good news for both patients and the NHS is that cost and quality of care are not in conflict because ‘looking after hip fracture patients well is much cheaper than looking after them badly’.

Speaking before the launch, Professor Dave Marsh, orthopaedic surgeon, said:
“There is overwhelming evidence that shows we can prevent thousands of patients from suffering from hip fractures, yet the vast majority are not even being assessed.

Hip fractures are threatening to overwhelm trauma and orthopaedic units, and it’s vital that managers and clinicians know exactly how they are doing if they are to have any hope of providing a better service. We know what best practice is, and the National Hip Fracture Database will give everyone a chance to aim for it”.

Dr Colin Currie, Geriatrician said:
“Substandard hip fracture care is common and the human cost is enormous. Too often our patients endure avoidable delay, avoidable pain, unnecessary time in hospital and – worst of all – unnecessary loss of cherished independence. We can and should do better, and the Blue Book and the NHFD will help.”

Note: this issue was covered by the media on 19 September

BGS Newsletter, October 2007
Issue 13 ISSN 1748-6343 13