1. Outcomes following NOF Fracture
Ann-Marie Davies
Senior Physiotherapist T+O, Morriston Hospital
National guidelines suggest that all patients suffering fractured neck of femur (NOF), should receive a Physiotherapy Assessment and be mobilised on the day of /or following surgery (1)(2). On analysis of our data it is clear that we are unable to reach this target for 100% of our patients. The reasons behind this were unclear and the causative effect of this delay had not been studied in our cohort of patients.
Analyse how many patients were able to mobilise day one following surgery.
Discover what the barriers are to mobilisation
Analyse outcomes for both groups of patients.
In conclusion we can ascertain that patients who do not get out of bed in the first day following surgery, have a longer length of stay, are less likely to be discharged home from their acute stay and more likely to require in-patient rehabilitation. This discrepancy may be for several reasons including poor pre-morbid state, however we should also consider whether there are any interventions which could be carried out pre and peri-operatively in order to improve patient’s condition in the post operative phase. This audit provides us with baseline facts regarding the effects of early mobilisation in this small cohort of patients but further work needs to be done in order to fully investigate the reasons why this group of patients have considerably better outcomes.
All patients admitted to Morriston Hospital in December 2018 with a diagnosis of NOF fracture were studied (50 patients). The data regarding when a patient first mobilised, the reasons why they didn’t mobilise, when they first mobilised independently, LOS and discharge destination were collected prospectively and analysed.
1) National Institute for Health and Clinical Excellence. Hip Fracture: Management CG124. London: National Institute for Health and Clinical Excellence ) NHFD 2018 annual report. 3) Johansen A, Boulton C, Burgon V, Rai S, Ten Hove R, Wakeman R. Using the National Hip Fracture Database (NHFD) to define the impact of physiotherapist assessment on early mobilisation after hip fracture. Physiotherapy Journal 2017;103(1),e85