Anaesthesia run chart

Almost all patients with a hip fracture will benefit from surgical treatment. Hip fracture surgery can be performed with the patient unconscious (general anaesthetic) or with an injection into the lower spine so they are unable to feel anything below the waist (spinal anaesthetic). Both are effective, but each technique will have advantages and disadvantages in different patients, and the National Institute for Health and Care Excellence (NICE) recommend that anaesthetists should discuss these when helping patients to decide on the approach best suited to their individual circumstances.

• General vs. Spinal Anaesthesia: The graph includes all operated patients and shows the percentage of patients who had a general anaesthetic and the percentage who had a spinal anaesthetic (but not both).

• Nerve blocks: The graph shows the proportion of operated patients having a nerve block in addition to either a general anaesthetic or spinal anaesthetic intra-operatively. Nerve blocks are recommended by NICE as one option for pain control where tablets and other pain killers are insufficient. Local anaesthetic is injected into the groin to numb the area around the hip. This injection can be given in the casualty department or on the ward before surgery, or in the operating theatre as part of the anaesthetic. Pre-operative nerve blocks are shown as a percentage of all patients admitted.

For more information on hip fracture, please see the NHFD patient report ‘My Hip Fracture Care: 12 questions to ask’. This is a guide to hip fracture injury and treatment for patients, their families and carers and is available on the NHFD homepage: www.nhfd.co.uk

Technical Summary
This run-chart shows:
1. The average % number of patients having a general anaesthetic only*
2. The average % number of patients having a spinal anaesthetic only*
3. The average % number of patients having a general anaesthetic with Nerve Block
4. The average % number of patients having a spinal anaesthetic with Nerve Block
5. The average % number of patients having a nerve block on arrival / before theatre
* If a patient is given both a spinal and general, this is not counted. (Refer to definitions below for details of each trace displayed)

Data selection
The chart includes all patient records from April 2011 to the end of the month before the previous month, but excluding:
1. Patients < 60 years old
2. Duplicate records, where detected
3. Data errors (Missing data/erroneous data or record conflicts, where detected)

Time axis
The charts use 'Admission Date' as the main monthly time-base. Patients are counted based on the year and month they were admitted to Hospital (acute stay).

Update frequency
Chart data is updated every hour, but only records older than the current or previous month will be included.

Definitions
% Rate of Spinal Anaesthesia (SA)
N: cases where a spinal anaesthetic has been administered (a value ‘SA only’ or ‘SA + nerve block’ or ’SA + epidural (CSE)’ or similar)
D: total cases having an operation (except those patients having both general and spinal anaesthesia)

% Spinal Anaesthetic with nerve block
N: cases where anaesthesia includes both spinal anaesthetic and nerve block
D: cases where only a spinal anaesthetic has been administered (‘SA only’ + ‘SA + nerve block’ + ‘SA + epidural (CSE)’)

% Rate of General Anaesthesia (GA)
N: cases where a general anaesthetic has been administered (a value of‘GA only’ or ‘GA + nerve block’ or ‘GA + epidural anaesthesia’ or similar)
D: total cases having an operation (except those patients having both general and spinal anaesthesia)

% General Anaesthetic with nerve block
N: cases where anaesthesia includes both general anaesthetic and nerve block
D: cases where only a general anaesthetic has been administered

Given nerve block pre theatre %
N: cases where nerve block is given pre theatre.
D: all admitted cases
(Note: this figure is independent of nerve-block given intra operatively).

Average percentage data calculations
An annualised rolling average calculation is used: Sum(X) / Sum(N) over the preceding 12 month period, for every month and recorded in the last month of the period. Since a value for the first 12 month period is displayed on the 12th month, the first 11 months do not display a value.