The 'Overall Performance' run-chart shows:
• Mean time to surgery: The chart shows the average number of hours between admission to A&E and surgery, for all patients operated that month. The graph also shows the national average for comparison. NICE guidelines recommend that surgery should take place on the day of admission to hospital or the following day. This is because it is uncomfortable, undignified and distressing to be confined to bed with a hip fracture and patients are unable to get up out of bed until they have had the operation. This recommended time for surgery may not be possible for some patients – for instance if they have medical problems which need other treatment first to make them well enough for surgery.
• Crude 30-day mortality: Since the NHFD was set up, there has been a steady improvement in the number of people surviving a hip fracture, but a proportion of the frailest will die in the weeks following this injury. In most cases this reflects how unwell they were before they suffered the hip fracture. In England and Wales (but not Northern Ireland) we can check with the Office of National Statistics (ONS) to see whether patients have died in hospital or at home after their hip fracture. The graph shows the proportion of patients who died in the first 30 days. It takes time to cross-check these figures so this graph cannot show the last few months. We also show a national average line for reference. However, some hospitals have patients who are older or frailer than those in other parts of the country. These hospitals might expect a slightly higher number to die after hip fracture, so the ‘crude 30-day mortality’ graph may not be reliable when comparing different hospitals’ performance. For this reason we perform an annual analysis that takes account of different patient populations. This ‘casemix adjusted 30-day mortality’ is reported in our annual report, and is the analysis which should be relied upon when comparing hospitals.
The annual report is available at www.nhfd.co.uk For more information on hip fracture, please see the NHFD patient report ‘My Hip Fracture Care: 12 questions to ask’. This is a guide to hip fracture injury and treatment for patients, their families and carers and is available on the NHFD homepage: www.nhfd.co.uk
Technical Summary
The 'Overall Performance' run-chart shows:
1. The number of patients admitted for treatment or care
2. The average time it took to deliver the patient to surgery (in hours)
3. The average number of people that have died within 30 days of admission
4. The underlying data used to calculate the averages
5. National averages based on NHFD data
Data Selection
The chart includes all records from April 2011 to the end of the month before the previous month, but excluding:
1. Errors (Missing data/Erroneous data)
2. Duplicates
3. Patients < 60 years old
4. Record Conflicts
5. Exceptional time to surgery in excess of > 450 hours
Time Axis
The charts use 'Admission Date' as the main monthly time-base. Patients are counted based on the year and month they were admitted to Hospital (acute stay).
Definitions and Data Calculations
Time to Surgery: Using the date and time of admission and surgery, the number of actual hours is calculated.
Mortality: If a patient dies within 30 days from the point of admission (day 0 - 29, whole days) they will be included in the 30 days mortality statistic.
Official mortality 'fact of death' data is provided by the HSCIC based on data obtained from the Office of National Statistics (ONS).
An annualised rolling average calculation is used: Sum(X) / Sum(N) over the preceding 11 month and current monthly period, for every month.
Update Frequency
Chart data is recalculated every hour, but only records older than the current or previous month will be included.
Notes
1. Mortality data is shown on the chart based on the last match undertaken. We link quarterly to data from the Office of National Statistics (ONS) to obtain date of death. In normal circumstances death data is available by that process within one month of the death, however in certain circumstances (such as death abroad or referral for coroner’s inquest) this can take longer. We have therefore truncated these charts according to the availability of data.
2. In accordance with NHS information governance guidelines, we are obliged to restrict the display of 'small numbers' to avoid disclosing patient identifiable data. Therefore, this chart shows a minimum of 5 patients per month, even if the actual number of patients was lower. This adjustment is applied to the data before being displayed on the charts.