1. Scottish Hip Fracture Audit 1993 - 2002 Change and opportunity

2. Scottish Hip Fracture Audit 9 years, 20,000+ cases 9 years, 20,000+ cases Follow-up at 4 months >95% Follow-up at 4 months >95% Coverage >50% of Scottish cases Coverage >50% of Scottish cases Useful to local clinicians in improving care Useful to local clinicians in improving care Allows national and international comparisons Allows national and international comparisons Main goals of 1991 application fulfilled Main goals of 1991 application fulfilled ‘Probably the best hip fracture audit in the world’ ‘Probably the best hip fracture audit in the world’

4. SHFA in 2002 Good/variable local use of data Good/variable local use of data Coverage remains patchy Coverage remains patchy National data underutilised National data underutilisedBut… Increased national-level support Increased national-level support National context changing National context changing

5. Changes over 2002/3 NHS Quality Improvement Scotland NHS Quality Improvement Scotland –Formerly CSBS/SHAS/CRAG/NAPEG etc etc Reallocation of central support for national audits? Reallocation of central support for national audits?

6. CSBS Standards for Older People in Acute Care (from 2002) Three common/generic journeys of care Three common/generic journeys of care Hip fracture as national tracer condition Hip fracture as national tracer condition Hip fracture standards x 4 – drawn from SIGN guideline – monitored by Scottish Hip Fracture Audit/CSBS

7. CSBS Standards for Hip Fracture Care Guideline-based; audit-monitored Through A&E within 2 hours Through A&E within 2 hours Surgery within 24 hours Surgery within 24 hours Multidisciplinary team care Multidisciplinary team care Participation in SHFA to ensure data & facilitate benchmarking Participation in SHFA to ensure data & facilitate benchmarking CSBS national report due in 2003

8. Improving quality and efficiency of hip fracture care in Scotland? CSBS Standards for Older People in Acute Care Scottish Hip Fracture Audit SIGN Guideline on Hip Fracture Care

9. Improving quality and efficiency of hip fracture care in Scotland? Scottish Hip Fracture Audit Scottish Hip Fracture Audit SIGN Guideline on Hip Fracture Care SIGN Guideline on Hip Fracture Care CSBS Standards for Older People in Acute Care CSBS Standards for Older People in Acute Care HipFest Meetings x 5: 1997-2002 HipFest Meetings x 5: 1997-2002 An interested and committed clinical community – with increasing national-level support? An interested and committed clinical community – with increasing national-level support?