Mobilisation after Fracture

Neck of Femur

Pradeep Chockalingam
Senior Physiotherapist

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Facts & Figures
 Occupies 20% of Orthopaedic beds.
Parrott S (2000)

 Average length of stay

20 days Parrott S (2000)
17.5 days Hamilton B , Bramley-Harker RE (1999)

 Average Cost per Patient £238 x 20

Days = £ 4760 (1998/99 cost). Parrott S (2000)

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Facts & Figures @ Q.E.H.
 No of Patients
219 (2003)
203 (2004)

 Length of stay
Mean 21.2 & Median 16 days (2003)
Mean 19.9 & Median 15 days (2004)

 30 day mortality rate

11.4 (2003)
13.8 (2004)
Edmonson JE (2005)

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Aim

 To find out when we are mobilising the

patient after surgery.

 If there is any delay what's the reason.

 What information we are giving to the

patients?
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Procedure
 Retrospective audit.

 Data collected for patients above 60 years

admitted between Oct 04 and Feb 05
 No. of admissions during the period :70

 No. records received for audit : 24 (20 full

records, 4 partial records & 46 records
were in various clinics).

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What are the standards?

 Day of 1st Mobilisation

 Information given to the patients

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 Day of 1st Mobilisation
 If medically stable rehab should begin within
24 hours. (S.I.G.N 2002)
 Mobilise as soon as possible on first or
second day. (N.Z.G.G 2003)
 By 48hrs. : if condition allows, start mobilise.
(Department Protocol, QEH)

 Most of the hospitals mobilised 50% of the

patients on day 2 (5/8), day 1(1/8). (Todd CJ 1995)

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Day of 1st Mobilisation

29%
Day 1
Day 2
Day 3>

24%

 Number of patients mobilised on 1st or 2nd

post OP day : 9/17 (Data missing: 4, RIP: 3)
 Number of patients mobilised on 3rd post OP
day or above : 8
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Reason for delay

 Week end : 4 (Mainly affected were

who had surgery on Thursday/Friday)

 Medical reasons : 4

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 Information given to the
patients
 “Let patients know in advance that they will
be encouraged to move within 24 hours.
Acknowledge that starting to walk again is a
challenge and will be uncomfortable”.
(S.I.G.N 2002)

 An audit by Southern Derbyshire Acute

Hospital NHS Trust (2002/3) revealed that
patients were not receiving any kind of
information. Now they ensure patients
receive appropriate information Booklet.

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 Information given to the
patients

 Educational hand outs issued : 0% (0/22),

(Data missing-2).

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Suggestions/Recommendations
 To produce and issue new patient
information leaflet. (as hospital withdrew
the fracture neck of femur leaflets from
the intranet)
 Organising early check x-ray, especially
for patients having surgery on
Thursday.
 Re-audit (Prospective).
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Limitations

 Approx. 11.82% of the records only

analysed in this audit.

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 References
 Dept. of Orthopaedic Physiotherapy, Protocol for Physiotherapy
treatment for Fracture Neck of Femur. Gateshead Health NHS
Foundation Trust.

 Edmonson JE. (2005). Presentation: Fractured neck of femur

audit. Gateshead Health NHS Foundation Trust.

 Hamilton B, Bramley-Harker RE. (1999). The Impact of the NHS

Reforms on Queues and Surgical Outcomes in England:
Evidence from Hip Fracture Patients. The Economic Journal.
109( 457): 437-62.

 Parrott S. (2000). The Economic Cost of Hip Fracture in the UK.

The University of York. website:
http://www.dti.gov.uk/homesafetynetwork/pdf/hipfracture.pdf

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 References

 Scottish Intercollegiate Guidelines Network. (2002). Prevention

and Management of Hip Fracture in Older People, A national
clinical guideline. Royal college of Physicians Edinburg.

 Southern Derbyshire Acute Hospitals NHS Trust. (2002/3).

Theme 1 – Managing the whole pathway for trauma patients. In:
Publication of the results of the extended development projects
funded by Action On Orthopaedics in 2002/3. NHS
Modernisation Agency. website:
http://www.wise.nhs.uk/sites/clinicalimprovcollab/orthopaedics/Docume
nt%20Library2/1/Action%20on%20Orthopaedics%20Development%20
Project.doc

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 References
 New Zealand Guidelines Group. (2003). Best Practice
Evidence-Based Guideline, Acute Management and Immediate
Rehabilitation after Hip Fracture amongst People aged 65 years
and over. New Zealand Guidelines Group. website:
http://www.nzgg.org.nz/guidelines/0007/Hip_Fracture_Management_Fu
lltext.pdf

 Todd CJ et al. (1995) Differences in mortality after fracture of

hip: the East Anglian audit. BMJ. 310(April 8): 904-908

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 Bibliography

 Handoll HHG, Sherrington C, Parker MJ. (2004).

Mobilisation strategies after hip fracture surgery in
adults. The Cochrane Database of Systematic
Reviews, Issue 4. Art. No.: CD001704. DOI:
10.1002/14651858.CD001704.pub2.

 National Services Scotland. (2004). Scottish Hip

Fracture Audit Report: National Table. National
Services Scotland. website: http://www.show.scot.nhs.uk/shfa

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Thanks
 Dept. of Clinical Audit
 Dept. of Health Records
 Dept. of Orthopaedics
 Dept. of Ortho. Geriatrics
 Dept. of Nursing
 C.O.R.T
 Orthopaedics Physiotherapy Team
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Thank you

Pradeep Chockalingam
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