National Hip Fracture Database

National Hip Fracture Database
Name	National Hip Fracture Database
Founded	2007
Headquarters	United Kingdom
Type	Clinical audit registry
Purpose	Improve care for hip fracture patients
Region served	England, Wales, Northern Ireland
Parent organization	Royal College of Physicians

National Hip Fracture Database The National Hip Fracture Database (NHFD) is a United Kingdom clinical audit registry that collects and analyses data on hip fracture care to improve outcomes for older adults. It links clinical practice with performance metrics used by institutions such as the Royal College of Physicians, the British Orthopaedic Association, the National Institute for Health and Care Excellence, and the Care Quality Commission. The NHFD supports multidisciplinary teams across hospitals including University College London Hospitals, Oxford University Hospitals, and Manchester University NHS Foundation Trust.

Overview

The NHFD operates as a national clinical audit similar in scope to registries such as the National Joint Registry, the Trauma Audit and Research Network, and the Scottish Hip Fracture Audit. It aggregates patient-level data from emergency departments at hospitals like Guy's and St Thomas', Addenbrooke's Hospital, and St George's Hospital, and coordinates with organisations including NHS England, NHS Wales, and NHS Improvement. Stakeholders range from orthopaedic surgeons at institutions such as Royal Liverpool University Hospital and King's College Hospital to geriatricians affiliated with Newcastle upon Tyne Hospitals and physiotherapists from Salford Royal. The NHFD interfaces with professional bodies including the British Geriatrics Society, the Royal College of Physicians, and the Royal College of Surgeons, and aligns with guideline-producing bodies such as the National Institute for Health and Care Excellence and the British Orthopaedic Association.

History and Development

The NHFD was established in 2007 following initiatives from clinical leaders and professional organisations to address variation in hip fracture care after analyses by the Healthcare Quality Improvement Partnership and national audits. Early pilots involved centres such as University Hospitals Birmingham and Sheffield Teaching Hospitals, with methodological input from academic groups at the University of Oxford, University of Cambridge, and Imperial College London. Over successive annual reports the database expanded coverage through collaborations with organisations like the British Orthopaedic Association, the British Geriatrics Society, and the Falls and Fragility Fracture Audit Programme. Policy interactions included responses to reports from the National Audit Office and recommendations by the Department of Health and Social Care. International parallels developed with registries such as the Australian and New Zealand Hip Fracture Registry and the American College of Surgeons National Surgical Quality Improvement Program.

Governance and Funding

Governance structures reflect partnerships among the Royal College of Physicians, the Healthcare Quality Improvement Partnership, and NHS England, with oversight from advisory panels including representatives from the British Orthopaedic Association and the British Geriatrics Society. Funding has combined grant support from organisations such as NHS England, the Department of Health and Social Care, and charitable contributions from entities similar to the Health Foundation and the Wellcome Trust. Operational management has been undertaken by teams linked to academic centres at University College London, the University of Nottingham, and the University of York, with contractual relationships involving Health Data Research UK principles and alignment with NHS Digital for data flow agreements.

Data Collection and Methodology

The NHFD collects demographic, clinical, perioperative, and outcome data on hip fracture patients from participating hospitals including those in the National Health Service and specialist hospitals such as Moorfields and Papworth. Variables include time to surgery, anaesthesia type, perioperative care by orthopaedic and geriatric teams, and discharge destination—data elements harmonised with international registries like the Fragility Fracture Network and the International Society of Orthopaedic Surgery and Traumatology. Methodology draws on statistical approaches used by the National Joint Registry and Trauma Audit and Research Network, with risk adjustment models informed by academic research from University of Edinburgh, University of Glasgow, and Queen Mary University of London. Data submission workflows integrate electronic health record systems deployed at NHS Trusts, and data governance follows standards influenced by NHS Digital, the Information Commissioner's Office, and the Health Research Authority.

Quality Measures and Reporting

NHFD reporting emphasises process and outcome measures such as time to surgery, early mobilisation, geriatrician review, and 30-day mortality—metrics comparable to performance indicators used by the Care Quality Commission and the National Institute for Health and Care Excellence. Annual reports benchmark hospitals including regional centres such as Chelsea and Westminster Hospital, University Hospitals Coventry and Warwickshire, and Leeds Teaching Hospitals. Quality improvement initiatives driven by NHFD data have been promoted through collaborations with professional societies including the British Orthopaedic Association, British Geriatrics Society, and the Royal College of Physicians, and presented at meetings of the British Orthopaedic Association, European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, and the American Academy of Orthopaedic Surgeons.

Impact on Clinical Practice and Outcomes

Analyses from the NHFD have been associated with reductions in time to surgery, increased orthogeriatric involvement, and improvements in metrics such as 30-day mortality and length of stay at trusts including Brighton and Sussex University Hospitals and University Hospitals Bristol and Weston. Findings have informed guideline development by bodies such as the National Institute for Health and Care Excellence and practical quality improvement programmes at hospitals like St James's University Hospital and King's College Hospital. The database has enabled research collaborations with academic institutions including University of Southampton, University of Leicester, and University of Manchester, producing evidence cited in policy dialogues involving the Department of Health and Social Care, NHS England, and clinical guideline committees.

Challenges and Future Directions

Challenges for the NHFD include ensuring complete case ascertainment across diverse NHS Trusts, integrating data from evolving electronic record systems used at organisations like Barts Health, handling linkage with national mortality datasets managed by the Office for National Statistics, and maintaining sustainable funding akin to other national audits supported by NHS England. Future directions emphasise interoperability with registries such as the National Joint Registry, enhanced patient-reported outcome measures developed in academic centres like University of Exeter, and expanded research partnerships with institutions including King's College London and University of Aberdeen. Strategic priorities include promoting implementation science collaborations with bodies like the Health Foundation and Academy of Medical Royal Colleges to translate audit findings into system-level improvements across hospitals and clinical networks.

Category:Clinical audit Category:Medical registries