OP2026 Oral Communications Oral Communications 2: Quality Improvement Projects (15 abstracts)
Mapping indicators for the older patients with falls and fragility fracture in England and Wales
Franz Clemeno 1 , Rumneet Ghumman 2 , Elizabeth Fagan 2 , Laura Pugh 3 , Maria Panourgia 4 , Julie Whitney 5 , Antony Johansen 6 , Bonnie Wiles 2 , Rosie Dickinson 2 , Muhammad Javaid 1 & Sunil Nedungayil 7
1University of Oxford, Oxford, United Kingdom;2Royal College of Physicians, London, United Kingdom;3Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, United Kingdom;4Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, United Kingdom;5King’s College Hospital NHS Foundation Trust, London, United Kingdom;6Cardiff and Vale UHB, Cardiff, United Kingdom;7East Lancashire Hospital NHS Trust, Blackburn, United Kingdom
Background: There are currently three audits benchmarking the quality of care across hip fracture care (NHFD), inpatient falls (NAIF) and secondary fracture prevention (FLS-DB). While covering a similar patient group, these audits are reported separately using different indicators. This makes it challenging to understand if hospitals are underperforming in indicators across all audits or just a few. We aimed to produce an aggregated Falls and Fragility Fracture dashboard to inform hospitals of their overall performance and identify cohorts of hospitals with similar performance gaps.
Methods: The clinical leads for each audit identified 23 high-level indicators: from NHFD KPI 2 Prompt surgery, KPI 4 Promptly out of bed, KPI 6 Return to original residence; from NAIF KPI 1 Multifactorial Assessment to optimise Safe Activity (MASA) and KPI 4 Cases that received a medical assessment within 30 minutes of a fall; and from FLS-DB KPI 3 identification of spine fractures; KPI 10 Treatment initiation within 16 weeks of fracture diagnosis, KPI 11 Treatment persistence at 52 16 weeks of fracture diagnosis. We excluded FLSs that received cases from more than one NHFD hospital. Hierarchical clustering was used to identify unique clusters across the three audits using 2024 audit data. The silhouette score was used to define the degree of clustering in the data, with a score of 0.5 indicating reasonably clustered data.
Results: We excluded 6 FLS that received cases from more than one NHFD site. Data from 44 NHS Trusts/Health boards were used. Although 3 clusters were identified, the silhouette score was 0.128, indicating a very weak clustering structure in the data.
Conclusion: We developed a dashboard across each site and the three audits. However, the very low silhouette score suggests that achieving these core KPIs across the 3 audits does not yield distinct hospital clusters, and that each hospital faces unique challenges to effective care delivery across the audits. These findings underscore the need to develop generic service improvement skills across all healthcare professionals working in NFHD, NAIF and FLS-DB.
Volume 8
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