Quality standard
Quality statement 2: Timing and expertise for surgery
Quality statement 2: Timing and expertise for surgery
Quality statement
Adults with hip fracture have surgery on a planned trauma list on the day of, or the day after, admission. [2012, updated 2016]
Rationale
People with hip fracture can experience pain and anxiety while waiting for an operation. Delays in surgery are associated with negative outcomes for mortality and return to mobility. Therefore, it is important to avoid any unnecessary delays for people who are assessed as fit for surgery. A planned trauma list includes specific healthcare professionals with the expertise required for hip surgery. Senior staff supervision can help to reduce the risk of complications during the surgery.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
a) Evidence of local arrangements to ensure that people with hip fracture have surgery on a planned trauma list.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from service protocols.
b) Evidence of local arrangements to ensure that people with hip fracture have surgery on the day of, or the day after, admission.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from service protocols.
Process
a) Proportion of operations for hip fracture that are performed on a planned trauma list.
Numerator – the number in the denominator that are performed on a planned trauma list.
Denominator – the number of operations for hip fracture.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The National Hip Fracture Database (NHFD) records the time of the operation in relation to the admission.
b) Proportion of operations for hip fracture that are performed on the day of, or the day after, admission.
Numerator – the number in the denominator that are performed on the day of, or the day after, admission.
Denominator – the number of operations for hip fracture.
Data source: The Office for Health Improvement and Disparities (OHID) presents national data and data for other geographies supplied by NHS Digital's (Hospital Episode Statistics) and the Office for National Statistics (unrounded mid-year population) on the standardised rate per 100,000 of hip fractures in people aged 65 and over as part of the OHID Local Health – Small Area Public Health Data Profile – Disease and poor health profile. The NHFD records the time of the operation in relation to the admission.
Outcome
a) Postoperative complications for people with hip fracture.
Data source: The NHFD records data on reoperation (within 120 days), whether people developed pressure ulcers and whether inpatient fractures were sustained.
b) Length of hospital stay for people with hip fracture.
Data source: The NHFD records average length of stay.
c) Mortality for people having hip fracture surgery.
Data source: The NHFD records data on mortality rates, including rates of 30‑day case-mixed adjusted mortality.
What the quality statement means for different audiences
Service providers (hospitals) ensure that systems are in place for people with hip fracture to have surgery on a planned trauma list on the day of, or the day after, admission.
Healthcare professionals (such as specialists, orthogeriatricians and anaesthetists) perform hip fracture surgery on a planned trauma list on the day of, or the day after, admission.
Commissioners (such as integrated care systems) ensure that they commission services that have sufficient capacity for people with hip fracture to have surgery on a planned trauma list on the day of, or the day after, admission.
People with hip fracture have an operation carried out by a team of senior specialists on the day they are admitted to hospital or the next day.
Source guidance
Hip fracture: management. NICE guideline CG124 (2011, updated 2023), recommendations 1.2.1 and 1.5.1
Definitions of terms used in this quality statement
Planned trauma list
A planned trauma list is one with a rostered senior anaesthetist, senior surgeon and dedicated theatre time. [NICE's full guideline on hip fracture]