Fragility fractures – State of the nation Wales report 2022 (9 March 2023)

Summary

The Falls and Fragility Fractures Audit Programme (FFFAP) has published its State of the nation report 2022 for Wales, which examines how the care of inpatient falls and fragility fractures has changed since 2020. The programme uses three sources of data:

• National Hip Fracture Database (NHFD)
• National Audit of Inpatient Falls (NAIF)
• Fracture Liaison Service Database (FLS-DB)

Content

Key findings

National Hip Fracture Database (NHFD)

• The number of hip fractures changed very little during the pandemic, so this is an ideal marker of the pandemic’s impact on the care of frail and older people and shows how successive waves of Covid-19 affected outcomes (mobility, return home, length of stay and mortality) in Wales.

National Audit of Inpatient Falls (NAIF)

There were approximately 12,500 inpatient falls in 2021. These led to:

• over 195 hip fractures
• loss of confidence and slower recovery
• distress to families and staff
• litigation against health boards.

Fracture Liaison Service Database (FLS-DB)

• Based on 1,956 fragility fractures in 2020 and 2,033 fragility fractures in 2021, the number receiving FLS assessment within 12 weeks was similar in 2020 and 2021 (64% and 65% respectively).

Recommendations

• Local health boards should ensure that they have appointed an orthogeriatrician and that they actively support their leadership of multidisciplinary care in each trauma unit.
• Local health boards should ensure that falls teams in acute, community and mental health hospitals are included in quality improvement activities and are using the data from the National Audit of Inpatient Falls.
• With falls teams reviewing health board level data and implementing focused quality improvement interventions should help improve the quality and safety of care in hospitals.
• Health boards without an FLS should contact the Royal Osteoporosis Society and use their implementation toolkit to support them in preparing a business case.
• Health boards that already have an FLS should ensure it is actively participating in the FLS-DB, and meeting its expected outcomes as defined by the FLS-DB’s set of KPIs.