Falls are a significant cause of emergency admissions to hospital for older people, and are a major factor in people moving into nursing homes or residential care. Many falls are preventable by removing hazards, addressing deterioration in muscle strength, balance and vision, and being vigilant for issues caused by medication.
Most falls occur in people's homes, care homes or outside. However, some falls happen in people who are already in hospital where inpatient falls represent one of the most commonly reported patient safety incidents. These patients are already unwell and have a greater risk of falling. Undertaking key actions to prevent inpatient falls is a national Commissioning for Quality and Innovation (CQUIN) indicator for 2019-20. Measures to ensure that call bells, walking aids, and slippers are within easy reach and that patients are helped when they need the toilet are important.
Hip fracture is one of the most common serious injuries in older people, and often requires emergency anaesthesia and surgery. Patients may remain in hospital for a number of weeks, leading to one and a half million hospital bed days being used each year. NICE guidelines recommend that surgery should take place on the day of admission to hospital or the following day. This is because it is uncomfortable, undignified and distressing to be confined to a bed with a hip fracture, and patients are unable to get out of bed until they have had the operation. Having surgery within 36 hours may not be possible for some patients, for example if they have medical conditions which need to be treated first to make them well enough for surgery.
Patients who are physically and psychologically frail should receive the help and support they need to prevent falls and injuries such as hip fractures. The percentage of hip fractures that happen in hospital (rather than in homes, care homes and outside) is a measure of safety and the quality of care that older people are receiving in hospital.
In England, the percentage of hip fractures that were the result of an inpatient fall decreased from 5.4% in 2013 to 3.8% in 2015, where it has remained fairly steady since then. In Northern Ireland, the percentage remained very low (<0.5%) until 2014 when it began to increase, reaching a high of 2.8% in 2017. Since then levels have fluctuated, but the proportion remains lower than in England. The proportion of hip fractures that occur in hospital is higher in Wales; a peak of 7.8% was reached in February 2014, but it has since decreased to 5.2%. Note that it is the 12-month rolling average figures that are being reported here.
In 2010, the Department of Health introduced a Best Practice Tariff to reward hospitals in England that provide the key elements of hip fracture care for each patient. One of the criteria includes prompt surgery – the time to surgery with 36 hours from arrival in the A&E department to the start of anaesthesia (or from time of diagnosis if an admitted patient).
The percentage of hip fracture cases having prompt surgery has fluctuated over time in England, Northern Ireland and Wales, but at different levels. On average, 75% of hip fracture patients in England have surgery within 36 hours, compared with 63% of patients in Wales and only 24% of patients in Northern Ireland. The Scottish Hip Fracture Audit found that in 2018, 72% of patients had surgical repair of their hip fracture within the recommended 36 hours following admission, and this figure has not changed significantly over the past few years (data not shown).
About this data
This indicator uses data from The National Hip Fracture Database. Both charts show 12-month rolling averages. Patients are counted based on the year and month they were discharged from hospital. Patients under 60 years of age are excluded.