Hip Fracture Registry 2024 Clinical Standard Report

We are delighted to announce the release of the ninth annual report of the Australian and New Zealand Hip Fracture Registry (ANZHFR). This year’s report contains data on 3668 patient care episodes with the total number of records from New Zealand now totalling 23400. This report captures information on 89% of all hip fractures that occurred in New Zealand in 2023 with data completeness of 99%.

Hip fractures can be a devastating event for older people with many having significant loss of independence and a mortality rate of 27% at one year post hip fracture. The average age of these patients is increasing, and people aged 90 years and older make up 26% of hip fracture patients in New Zealand.

The focus of the ANZHFR is to measure care against the Hip Fracture Clinical Care Standards which were updated in September 2023. These were developed by the Australian Commission on Safety and Quality in Healthcare and endorsed by the Health Quality and Safety Commission New Zealand. Care is also audited against items in the Australian and New Zealand Guideline for Hip Fracture Care. This year the Golden Hip was again awarded to North Shore Hospital for the best performance against these indicators and to Timaru Hospital for making the greatest improvements in their performance.

It is pleasing to see ongoing improvements in several areas. Teams have clearly been putting a focus into ensuring that a person’s cognitive state is documented and that the presence of delirium is assessed before and after surgery. The assessment of clinical malnutrition has improved significantly, and further gains have been made in the completion of a frailty assessment.

The growing demand on Emergency Departments (ED) is well recognised and this is having an impact on the length of time a patient with a hip fracture spends waiting to be assessed and admitted. The average time in ED has risen from 6.6 to 7.5 hours and during this time 68% have pain relief administered either by the paramedic service or within 30 minutes of arrival to the hospital. The time to surgery is also increasing with an average time now of 38 hours. The Clinical Care Standard for 2024 is for patients to have received surgery within 36 hours. Meeting this standard will be a challenge and require collaboration between all stakeholders. The greatest reason for delays to surgery is theatre availability at 45%.

There are two areas which remain key targets for improvement. The number of people who stand and take a step on the day after surgery is only 39% and the rates of people discharging home on bone protection medication remains low at 37%.

Further information can be seen in the digital report available on our website https://anzhfr.org/registry-reports/.

This report is possible because of the extraordinary efforts of the teams involved in hip fracture care across Australia and New Zealand. We extend our sincere thanks to all those involved in Registry activities. We look forward to continuing to work together towards better outcomes for older people after hip fracture.

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