543 Improving Outcomes in Patients with Fragility Femur Fractures: A Quality Improvement Project

Aim To improve compliance with measurable variables of the Best Practice Tariff (BPT) for fragility femur fractures. These include Abbreviated Mental Test Score (AMTS), 4AT delirium screen, Malnutrition Screening Tool (MUST) and Falls Assessment. Method Utilising the Plan-Do-Study-Act (PDSA) methodology, a quality improvement project was designed in a UK district general hospital to enhance compliance with four BPT measurable variables. Retrospective baseline data collection commenced in November 2022. The first PDSA cycle, in April 2023, resulted in the introduction of daily fractured femur reports, identifying patients admitted with a fragility femur fracture and tracking completion of the BPT parameters. The second PDSA cycle, in August 2023, involved teaching sessions at the junior doctor induction and the creation of a fragility femur fracture handbook for junior doctors facilitating accurate completion of BPT parameters on the patient electronic records. Prospective identification of post-intervention patients allowed for comparison of pre-intervention and post-intervention compliance. Results From November 2022 to October 2023, 331 patients over 60 were admitted with a fragility femur fracture. Following the PDSA cycles, completion rates for AMTS and 4AT assessments rose from 54.5% to 100% and 16.6% to 97.8%, respectively. MUST assessment completion improved from 82.7% to 100%, while falls assessment consistently exceeded 95%. Conclusions The project demonstrated the need to enhance best practices in fragility femur fracture care. Targeted junior doctor education and addressing assessment completion gaps significantly improved BPT compliance, leading to overall elevated care standards. Moreover, meeting BPT criteria contributed to increased revenue, allowing the trust to receive up to £100,000 annually.