Improving the care of patients with a hip fracture: a quality improvement report.

INTRODUCTION: Hip fractures are associated with high rates of morbidity and mortality and their incidence is set to increase. The National Hip Fracture Database and the Best Practice Tariff were introduced with the aim of improving patient care. This complete audit cycle charts the substantial clinical improvements that were achieved in a busy district general hospital. METHODS: The first audit cycle comprised 379 patients who were admitted between May 2012 and April 2013. The primary audit criterion was operative intervention within 36 h of admission. Variation according to the day of the week of admission was assessed to evaluate specific deficiencies in local service provision. The principle audit intervention was the introduction of two additional morning trauma lists. A re-audit of 162 patients was conducted prospectively between January 2014 and June 2014. RESULTS: Mean time to theatre was 49±39 h during the first audit cycle compared with 27±19 h (p<0.0001) during the second. Consequently, the proportion of patients undergoing operative intervention within 36 h of admission improved from 41% to 78% (p<0.0001). Overall achievement of Best Practice Tariff was significantly higher during the second cycle: 28% vs 73% (p<0.0001). CONCLUSIONS: Significant improvements in the quality of hip fracture care were achieved following this audit. These were accomplished by rigorously analysing the variation in Best Practice Tariff achievement according to the day of the week on which patients were admitted. Targeted interventions could therefore be introduced that addressed specific problems in local service provision.

Competency mapping in quality management of foundation training.

Competency-based curricula focus on outcomes in terms of application of knowledge and acquisition of competencies. The aim of this exercise was to analyse posts and programmes for potential training outcomes. A mapping process against the UK foundation curriculum was designed. Data were gathered from foundation directors using red/amber/green judgements for each post. After submission no correspondence was needed on any programme about educational arrangements, suggesting the process had a significant formative effect as well as assessing outcomes. Certain competencies were problematic across the majority of host providers, allowing programme directors to ensure deficiencies are compensated by planned teaching or simulation training. Widespread difficulty in achieving these competencies raises the question of whether they should be included within the national curricula. Development of competency-based training is a complex, multistep process. However, it is possible to analyse it in a large programme of trainees in the setting of the modern, busy NHS.