866 Improving the Quality of Clinical Coding and Documentation to Record Accurate Outcomes in Non-Operatively Managed Hip Fractures

Abstract

Abstract Background Our 2019 Clinical Audit for non-operatively managed hip fractures at our Trust was 9.76% against the national standard of 5% at The National Hip Fracture Database (NHFD) annual report 2017. A re-audit was conducted to review reasons for higher incidence as recommended by NICE and improve outcomes. Method Hip fracture patients admitted between 1st April 2019 and 31st August 2020 to Southport and Ormskirk NHS Trust were reviewed clinico-radiologically. Data was collected from NHFD, EVOLVE patient records, and PACS imaging systems. Following appropriate “Primary Diagnosis” of hip fracture, confirmation of operative or non-operative management was undertaken following a joint assessment by the Orthopaedic staff and the Clinical Coding department evaluating reasons behind the decision. Secondary outcome measures compared 30-day and one-year mortality with the previous cohort. Results In the re-audit, 512 cases were reviewed, 50 patients excluded following correct Clinical Coding, 440 hips were operated and 22 (4.8%) managed non-operatively. However, 30-day mortality rose from 30.5% during the audit to 54.50% possibly due to the effect of COVID-19. Conclusions The newly introduced “Neck of Femur Proforma” has remarkably improved the quality and organization of clinical documentation of diagnosis. Appropriate Clinical Coding allows correct information for the NHFD Trust figures.