The 2022 annual report of the National Hip Fracture Database (NHFD) is designed to help local hip fracture teams exploit the NHFD website’s resources, with governance tools providing links to key information, graphs and tabulated data. This year we have focussed on how hospitals can use make the most of their data to improve care through Quality Improvement. We encourage you to look at our new Quarterly Governance Tool to identify areas of improvement.

The annual report encompasses the whole of 2020 and 2021, to demonstrate how care compares with that prior to the COVID-19 pandemic. It builds on the detailed analysis of our six Key Performance Indicators (KPIs) in last year’s report, and seeks to look forward with innovations including new KPIs designed to examine the very first and final stages of each patient’s care pathway.

Key recommendations

• Use the NHFD as a driver for QI
Quarterly governance meetings should be taken as an opportunity for team members and trainees from all disciplines to make use of the NHFD website as a driver for QI; the new Quarterly Governance Tool is designed to help them do this.

• Improve initial care (KPI 0)
Hip fracture teams should use KPI 0 as a marker of initial care and a driver to improve the provision of local anaesthetic nerve blocks and fast-tracking of patients to an appropriate ward. Performance should be considered alongside the figures for their unit in the Anaesthesia run chart and Assessment benchmarking table.

• Avoid further fragility fractures (KPI 7)
To help patients avoid further fragility fractures, hip fracture team governance meetings should review KPI 7 alongside their Bone Medication Table and arrangements for 120-day follow-up.

• Minimise inequalities
Hip fracture teams should minimise inequalities in health care; specifically by reviewing whether support and information is provided in formats and languages appropriate to their patients.




The National Hip Fracture Database continues to monitor and provide guidance for the improvement of care in older patients admitted to hospital with fragility fractures of the femur. This report highlights the evolution of this care to encompass injuries throughout the femur. It provides an overview of patient management from early phases of interaction between Emergency Departments and receiving wards, through perioperative care and onward rehabilitation. We encourage the reader to reflect on the two new Key Performance Indicators enabling assessment of care at the very first and final stages of each patient’s care pathway.Will Eardley, Surgeon, NHFD surgical clinical lead

As we move to a new era of quarterly reporting, this report shows teams how to use the live data on the NHFD website to inform governance meetings and local improvement work. The challenges facing the NHS mean that services are developing rapidly and need to be able to respond quickly to problems as they arise. The new Quarterly Governance Tool is an opportunity for team members and trainees from all disciplines to make use of the NHFD website as a driver for QI.Antony Johansen, NHFD orthogeriatrician clinical lead