Advancing Quality (AQ) hip fracture programme: A large scale programme to improve nutritional assessment in people...

Advancing Quality (AQ) has high reliability and is effective at reducing unwarranted variation in care programme operated by the Advancing Quality Alliance (AQuA). Established in 2008, AQ aims to support NHS healthcare organisations toimprove the reliability of clinical practices so that every patient consistently
receives the highest quality care possible, every time. Our work with
dedicated clinical teams and managers aims to improve health outcomes for
patients and the population whilst reducing unwarranted variation in highly prevalent conditions.

The population is identified retrospectively using ICD1-0 codes and a standardised data collection tool is used to assess management of people >60 years of age with a HFR, either on arrival to hospital or during their admission.

7317 patients had a nutritional screen recorded using the MUST score between January 2015 and December 2016. In hospital mortality for patients receiving nutritional screen within 24 h was 6.1% compared to 9.3% for screens after 24 h, p < 0.001 (Fisher's exact test). Mortality rate for those patients without a risk score recorded was 9.4%.The number of patients receiving nutritional screen within 24 h, improved from 86% to 94%.

Inpatient mortality was significantly lower in patients who had their MUST score within 24 h of admission. This is likely attributed to the improvement of the overall package of care if their assessment is performed early in those patients who are admitted to an orthopaedic or neck of femur ward. An early MUST score identifies nutritional deficiency and those at risk allowing measures can be taken to address malnutrition early during the inpatient stay.