{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T10:14:19Z","timestamp":1777284859754,"version":"3.51.4"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Trauma in older people leads to substantial morbidity and mortality. The National Hip Fracture Database (NHFD) has driven improved practice with units compared to identify outliers. In 2013, our unit was an outlier for mortality post hip fracture (30-day mortality 12.2% vs. 8.3% nationally). This triggered external review. In 2019 the unit was highlighted as an exemplar in the UK. We describe the process that moved us from outlier to outstanding. After the initial review process, we made changes to our healthcare system, with regular reassessment of progress and care quality. Examples include a dedicated hip fracture unit, strong leadership (Nursing, Orthopaedic, Geriatrician, Anaesthetic), consultant-led in-depth monthly mortality reviews, changes to admission pathways and delirium prevention. Improvements were seen in all aspects of hip fracture care in 2019 compared with 2012. Thirty-day case-mixed adjusted mortality halved (12.2\u20136.1%), with substantial reductions in reoperations and pressure sores. Length of stay reduced by 5.9 days. In 2019 our unit\u2019s performance was significantly above the national average for all six indicators assessed by NHFD: prompt orthogeriatric review (97% vs. 91% national average), prompt surgery (85% vs. 68%); NICE compliant surgery (85% vs. 74%); prompt mobilisation (93% vs. 81%); not delirious postoperatively (77% vs. 69%); return to original residence (78% vs. 71%). The NHFD highlighted our Unit as one of nine (from 175 total) highly performing UK trusts. We summarise our service development and improvement work undertaken to achieve \u2018outstanding\u2019 status, which provides a valuable template to units managing trauma in older people.<\/jats:p>","DOI":"10.1093\/ageing\/afac163","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T18:40:33Z","timestamp":1659724833000},"source":"Crossref","is-referenced-by-count":7,"title":["Trauma care in older people: charting a path from outlier to excellence"],"prefix":"10.1093","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1098-9230","authenticated-orcid":false,"given":"Gulraj S","family":"Matharu","sequence":"first","affiliation":[{"name":"Musculoskeletal Research Unit , Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael R","family":"Whitehouse","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Unit , Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol BS10 5NB , UK"},{"name":"Department of Trauma and Orthopaedic Surgery , Southmead Hospital, Bristol BS10 5NB , UK"},{"name":"National Institute for Health Research Bristol Biomedical Research Centre , University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Harding","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery , Southmead Hospital, Bristol BS10 5NB , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery , Southmead Hospital, Bristol BS10 5NB , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery , Southmead Hospital, Bristol BS10 5NB , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,8,2]]},"reference":[{"key":"2022080518402733000_ref1","volume-title":"The National Hip Fracture Database Annual Report","year":"2020"},{"key":"2022080518402733000_ref2","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1111\/anae.13908","article-title":"Understanding mortality rates after hip fracture repair using ASA physical status in the national hip fracture database","volume":"72","author":"Johansen","year":"2017","journal-title":"Anaesthesia"},{"key":"2022080518402733000_ref3","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s00198-015-3277-9","article-title":"Impact of hip fracture on hospital care costs: a population-based study","volume":"27","author":"Leal","year":"2016","journal-title":"Osteoporos Int"},{"key":"2022080518402733000_ref4","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1302\/0301-620X.97B3.35738","article-title":"Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick hip trauma evaluation \u2013 a prospective cohort study","volume":"97-B","author":"Griffin","year":"2015","journal-title":"Bone Joint J"},{"key":"2022080518402733000_ref5","author":"National Institute for Health and Care Excellence","year":"2011"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/51\/8\/afac163\/45216014\/afac163.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/51\/8\/afac163\/45216014\/afac163.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T18:40:38Z","timestamp":1659724838000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afac163\/6653478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8]]},"references-count":5,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2022,8,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afac163","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,8]]},"published":{"date-parts":[[2022,8]]},"article-number":"afac163"}}