James Wright, Australia
The Australian and New Zealand Hip Fracture Registry (ANZHFR) is one of many hip fracture registries internationally. To date, national hip fracture registries are established, or in development, in 18 countries across Asia Pacific, Europe, Latin America and North America (Ref - Asia Pacific Fragility Fracture Alliance, 2021)
Hip fracture is recognised as the most serious and costly fall-related injury suffered by older people, the causes, and consequences of which are well-understood by emergency physicians. The ANZHFR is a clinical quality registry that collects data about the care of older people admitted to a hospital with a hip fracture in Australia and New Zealand with the explicit intent that the data is used to drive improvements in care. To date, it has collected data on more than 71,000 patients, as well as the processes and models of care in place in 118 public hospitals.
The Registry aligns its data collection and reporting to the Hip Fracture Care Clinical Care Standard. A Clinical Care Standard is a small number of quality statements describing the clinical care a patient should be offered. It addresses the priority areas for quality improvement and those known to improve patient and health care service outcomes. For hip fracture, this includes timely assessment and management, timely surgery if indicated, and the early initiation of a tailored care plan aimed at restoring movement and function and minimising the risk of another fracture.
Each year the Registry team codesign the publication of the data that is publicly reported. The annual report supports sites to learn from each other and highlights exemplar care while encouraging teams to focus on areas where improvement is still needed.
Since the first annual report in 2016, the Registry has shown improvements in multiple care domains. Areas particularly pertinent to Emergency Departments include the assessment and management of pain and the assessment of cognition. The proportion of hospitals with a pathway or protocol for pain management has increased from 61% in 2014 to 84% in 2021. There have also been improvements in the use of nerve blocks, and there has been a year-on-year increase in the proportion of patients who had their cognition assessed with a validated tool before surgery.
This year, the Registry also has two exciting new pilot projects, collectively known as My Hip My Voice. The first is focusing on displaying data on hip fracture care and outcomes to consumers in a meaningful and easily understood format. The second is using an electronic system to collect patient-reported experience measures (PREM). Harnessing the older person’s voice is seen as key to improving care. Further information is available on the ANZHFR website, where there is a wealth of resources freely available.