National Hip Fracture Database – Audit Toolv8.03

Patient Information

First Name / Surname / NHS / CHI NumberB M
Date of BirthM / GenderM / Patient’s Post CodeM
__ __ /__ __ /______/  Male  Female
Patient ID / Hospital numberK

Admission

Hospital in which fracture is first identified / Residence at time of fracture M
 Own home/sheltered housing
 Residential care
 Nursing care
 Inpatient -on this hospital site
 Inpatient - other hospital site of this Trust
 Inpatient - another Trust
Admission with hip fracture via AE / Date & time of admission to A & E B M
 Yes
 No / __ __ / __ __ / ______:__ __hrs
Note: Usepresentation to trauma team if not admitted via A&E
Date/time of admission to orthopaedic/orthogeriatric wardM / Admitted using jointly agreed assessment protocol B
__ __ / __ __ / ______:__ __hrs
 Never admitted to orthopaedic/orthogeriatric ward /  Yes - assessment protocol in the notes
 No - assessment protocol not in the notes
Orthopaedic GMC number/nameB / Geriatrician GMC number/name B

Assessment

Pre-fracture mobility M
 Freely mobile without aids
 Mobile outdoors with one aid
 Mobile outdoors with two aids or frame
 Some indoor mobility but never goes outside without help
 No functional mobility (using lower limbs)
 Unknown
Abbreviated Mental Test Scores (AMTS) Pre op B / Abbreviated Mental Test Scores (AMTS) post op (in acute stay) B
1st AMTS …….. /10
 Not done/patient refused / 2nd AMTS …….. /10
 Not done/patient refused
Pathological MM / Side of fracture K
 Atypical
 Malignancy
 No
 Unknown /  Left
 Right
Type of fracture MM / Pre-op medical assessment M
 Intracapsular - displaced
 Intracapsular - undisplaced
 Intertrochanteric
 Subtrochanteric /  Specialist assessment by orthogeriatrician (grade ST3+)
 Specialist orthogeriatric assessment by specialist nurse
 Medical review following request(grade ST3+)
 None

Treatment

ASA grade / Date & time of primary surgery B
 1  2  3  4  5  Unknown / __ __ / __ __ / ______:__ __hrs
Operation PerformedM / Type of Anaesthesia
 Internal fixation - Sliding Hip Screws
 Internal fixation - Cannulated screws
 Internal fixation - IM nail (long)
 Internal fixation - IM nail (short)
 Arthroplasty - Unipolar hemi (uncemented- uncoated)
 Arthroplasty - Unipolar hemi (uncemented- HA coated)
 Arthroplasty - Unipolar hemi (cemented)
 Arthroplasty - Bipolar hemi (uncemented - uncoated)
 Arthroplasty - Bipolar hemi (uncemented – HA coated)
 Arthroplasty - Bipolar hemi (cemented)
 Arthroplasty - THR (uncemented - uncoated)
 Arthroplasty - THR (uncemented – HA coated)
 Arthroplasty - THR (cemented)
Arthroplasty - THR Hybrid
 Other
 No operation performed /  GA only
 GA + nerve block
 GA + spinal anaesthesia
 GA + epidural anaesthesia
 SA only
SA + nerve block
 SA + epidural (CSE)
 Other
Reason if delay > 36hours / Pressure ulcers M
 No delay- surgery < 36hrs
 Awaiting orthopaedic diagnosis/investigation
 Awaiting medical review/investigation or stabilisation
 Administrative/logistic- awaiting inpatient or high dependency bed
 Administrative/logistic - awaiting space on theatre list
 Administrative/logistic - problem with theatre /equipment
 Administrative/logistic - problem with theatre/surgical/anaesthetic staff cover
 Administrative/logistic - cancelled due to theatre over-run
 Other
 Unknown /  Yes
 No
 Unknown
Date & Time assessed by Geriatrician B / Geriatrician grade B
__ __ / __ __ / ______:__ __hrs /  Consultant
 SAS
 ST3+
 Unknown
 Not seen
Specialist falls assessmentB / Multidisciplinary rehabilitation team assessment B
 No
 Yes - performed on this admission
 Yes - awaits falls clinic assessment
 Yes - further intervention not appropriate /  Yes
 No
 Unknown
Bone protection medicationB M / Mobilised on day of or day following surgery
 Started on this admission
 Continued from pre-admission
 Awaits DXA scan
 Awaits bone clinic assessment
 Assessed - no bone protection medication needed/appropriate
 No assessment or action taken /  Yes - Physiotherapist
 Yes - Other
 No

K= key fields. If missing or invalid data entered, the record will be rejected.

M = mandatory fields. If missing or invalid data entered, the record will remain in draft form.

B = Required for Best Practice Tariff. If missing or invalid data entered BPT will not be available

Discharge

Date & time of discharge from acute Orthopaedic ward M / Discharge destination from acute Orthopaedic ward M
__ __ / __ __ / ______:__ __hrs /  Own home/sheltered housing
 Residential care
Nursing care
 Rehabilitation unit
 Acute hospital
 Dead
 Other
Date & time of final discharge from Trust M / Discharge destination from Trust M
__ __ / __ __ / ______:__ __hrs /  Own home/sheltered housing
 Residential care
Nursing care
 Rehabilitation unit
 Acute hospital
 Dead
 Other
 Unknown
Discharge date/time of final discharge from NHS care / Discharge destination from NHS care
__ __ / __ __ / ______:__ __hrs /  Own home/sheltered housing
 Residential care
Nursing care
 Rehabilitation unit
 Acute hospital
 Dead
 Other
 Unknown

Follow Up

30 days
Date...... / 120 days
Date...... / 1 year
Date......
Residential
status /  Own home/sheltered housing
 Residential care
 Nursingcare
 Rehabilitation unit
 Acute hospital
 Dead
 Other
 Unknown /  Own home/sheltered housing
 Residential care
 Nursing care
 Rehabilitation unit
 Acute hospital
 Dead
 Other
 Unknown /  Own home/sheltered housing
 Residential care
 Nursing care
 Rehabilitation unit
 Acute hospital
 Dead
 Other
 Unknown
Mobility /  Freely mobile without aids
 Mobile outdoors with one aid
 Mobile outdoors with one aid or frame
 Some indoor mobility but never goes outside without help
 No functional mobility (using lower limbs)
 Unknown /  Freely mobile without aids
 Mobile outdoors with one aid
 Mobile outdoors with one aid or frame
 Some indoor mobility but never goes outside without help
 No functional mobility (using lower limbs)
 Unknown /  Freely mobile without aids
 Mobile outdoors with one aid
 Mobile outdoors with one aid or frame
 Some indoor mobility but never goes outside without help
 No functional mobility (using lower limbs)
 Unknown
Bone protection medication /  Yes
 No
Unknown /  Yes
 No
Unknown /  Yes
 No
Unknown
Re-operation within 30 days of admission to A&E /  Reduction of dislocated prosthesis
 Washout or debridement
 Implant removal
 Revision of internal fixation
 Conversion to Hemiarthroplasty
 Conversion to THR
 Girdlestone/excision arthroplasty
 Surgery for periprosthetic fracture
 None
 Unknown
Note: Select most significant procedure only

Updated 4/4/2014 Page 1