Hip fracture audit: time for standards to be evidence-based

Hip fractures are a common and increasing problem. Outcome varies considerably between hospitals. The reasons for this variability are complex. To reduce inequality in patient outcome, management guidelines should be evidence-based. In order to assess quality of care, audit methods and targets should also be evidence-based. Most hip fracture audit in the UK is based upon non evidence-based guidelines and uses parameters of process rather than outcome. Current audit tools are insufficiently sensitive to account for differences in demography between hospitals. This may produce misleading results. In the space of 5 years, only modest improvements have been made in the care of patients with hip fracture. Audit tools should look at pre-existing comorbidity and functional outcome as well as the process of care, mortality and length of hospital stay. Future guidelines should be evidence-based, concentrate on outcome measures, and account for variations in demography.