News – July 2011

Around 70,000–75,000 hip fractures occur each year in the UK, with figures expected to increase as a consequence of the ageing population (although they can happen at any age). Management of hip fracture requires a multidisciplinary approach because the occurrence of fall and fracture often indicates ill-health. Approximately 10% of people with a hip fracture die within 1 month and one-third within a year. These deaths are mostly as a result of co-morbidities rather than the fracture itself.

Evidence has shown that prompt surgery and an effective Hip Fracture Programme can significantly improve the lives of patients by:

• reducing the length of hospital stays
• helping them to recover their mobility faster
• reducing the number of follow-up procedures.

In its first clinical guideline on hip fracture, NICE recommends that surgery for hip fracture should be carried out on the day of, or the day after admission. Correctable co-morbidities should be identified and treated immediately so that surgery is not delayed by conditions, such as anaemia or acute chest infection. A key priority for implementation is that patients are offered, from admission, a formal, acute orthogeriatric or orthopaedic ward-based Hip Fracture Programme as part of standard care.

Other recommendations from NICE on the management of hip fracture cover:

• imaging options in occult hip fracture
• analgesia
• anaesthesia
• planning the theatre team
• surgical procedures:
  • replacement arthroplasty
  • total hip replacements
  • use of extramedullary implants
• mobilisation strategies, which include offering patients:
  • physiotherapy assessment and mobilisation the day after surgery
  • mobilisation at least once a day and regular physiotherapy review
• multidisciplinary management and its role in:
  • the Hip Fracture Programme
  • early supported discharge
  • a palliative care approach.

www.nice.org.uk

Quality standard on chronic heart failure published by NICE

Heart failure affects one in every 100 people in the UK and around 30% of patients admitted to hospital for heart failure die within a year of admission. Patients often experience a poor quality of life with symptoms including breathlessness, fatigue, and ankle swelling. Over one-third of patients also experience severe and prolonged depressive illness. There is evidence to suggest that effective multidisciplinary specialist services can help reduce recurrent hospital days by 30%–50%. The new quality standard published by NICE for the assessment, diagnosis, and clinical management of chronic heart failure in adults aims to define quality care by providing clear, easy-to-understand definitions of high-quality healthcare.

The 13 quality statements describe markers of high-quality, cost-effective care that will contribute to improving the effectiveness, safety, and experience of care for people with chronic heart failure.

The statements cover:

• referring people for specialist assessment that includes echocardiography, within 2 weeks of presenting in primary care with suspected heart failure and previous myocardial infarction
• measuring serum natriuretic peptides
  in people presenting in primary care with suspected heart failure without previous myocardial infarction
• conducting a clinical assessment at least every 6 months that includes a review of medication and measurement of renal function in people with stable chronic heart failure
• offering a personalised management plan that is shared with the patient, their carers, and the GP for people admitted to hospital because of heart failure.

The quality standard requires services to be commissioned from and coordinated across all relevant agencies involved in the chronic heart failure care pathway. The standard will be useful for patients, carers, the public, healthcare professionals, commissioners, and service providers. The quality statements have been developed with the best available evidence and will also play a key role in the NHS Outcomes Framework.

www.nice.org.uk

NICE annual review for 2010/2011 is available online

An annual review has been published by NICE, giving an overview of its work throughout 2010/11. During the past year NICE has published 122 new pieces of guidance as well as the first eight quality standards. NICE also launched an online database designed to help GPs refer patients from primary to secondary care. The database will help reduce the number of inappropriate referrals and ensure value for money in the NHS. The Medical Technologies Evaluation Programme was also initiated in 2010. It has produced three pieces of guidance recommending innovative new technologies for use in the NHS.

www.nice.org.uk

National Osteoporosis Society releases anniversary report