Care for patients with hip fractures, including their rehabilitation, costs SEK 2.3 billion every year in Sweden. At age 50, the risk of fracturing a hip during the remainder of a person’s life is 23 percent for women and 11 percent for men.
The aim of registering patients with hip fractures is to present outcome data to facilitate comparison and create equitable, high-quality care nationwide. Comparisons between different regions and hospitals rapidly increase awareness of treatment results and accelerate improvements.
The evaluation parameters in RIKSHÖFT are the quality indicators that many county councils use to monitor their care processes. The time from arrival at the hospital until the patient undergoes surgery is a national quality indicator in SKL’s open comparisons. Another is the percentage of patients who return to their previous type of housing within four months. Meta-analyses of scientific studies show that short waiting times for surgery reduce care time (considerably more than the waiting time), complications and mortality.
RIKSHÖFT is also a model for quality control for other medical sectors characterised by a heavy use of resources and long chains of care. Close collaboration between hospital, primary care and municipal care providers is the basis for faster discharge home for these emergency patients, who have traditionally had long chains of care, with rehabilitation through institutional care providers and convalescent homes.
It is possible to evaluate different patient groups with hip fractures in regard to age, other conditions (ASA physical status classification) and functional level in relation to surgical method and use of resources. This also provides structural reorganisations a form for evaluation through continuum of care analyses and resource utilisation.
RIKSHÖFT has also served as a model for international registries, which have been in progress since 1993 in Scotland, have begun in Norway and England, and are due to start in Australia, New Zealand and Vancouver, Canada. Regional registries have spread in most European countries since the start of the SAHFE project.
SAHFE (Standardised Audit of Hip Fractures in Europe) was an EU project conducted from 1995 to 1998. It was initiated and managed by the registrar. Network projects for organisational development are now being started to introduce and evaluate on a larger scale the new principles of emergency care for hip fracture patients. Cooperation in the network is a learning process with continuous feedback.
Through RIKSHÖFT’s registration system, participating clinics have constant access to their own data for monitoring process developments. The registration of timestamps for arrival at the hospital and surgery start enables the calculation of waiting times for surgery down to the minute. This increases precision in the use of this national quality indicator for open comparisons.
Patients with all types of hip fractures and all surgical methods (even those who do not undergo surgery) are included in the registry. At present, 52 of the country’s 54 hospitals that perform emergency hip fracture operations participate in the registry. Re-operations within 10 years from the date of the primary surgery are registered. Checks performed by the hospitals show that about 16,500 people are affected annually in Sweden.
Age 15 and up. The annual report includes patients who are 50 years of age and older and who do not have a pathological fracture.
220,000 primary forms.
15,362 primary registered patients with hip fracture diagnosis in 2012. About 2/3 followed up after four months. A total of 591 re-operations on this patient group.
The coverage rate is 96 percent at primary registration and 59 percent at follow-up four months after the fracture.
Note: Variable lists are updated on a regular basis and should therefore be seen as preliminary. For the latest version, please contact the registry.
Category: Musculoskeletal system
Certification level: 1
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