1274 Adherence to Best Practice Tariffs for Femoral Fractures Excluding Neck of Femur Fractures (NOF's)

Aim In 2020/21 the UK BPT extended their patient cohort to include distal femur and femoral shaft fractures for time to surgery (TTS) of 36hrs. In 2018 UHB merging resulted in a new policy whereby all NOFs would be fixed at Birmingham Heartlands Hospital (BHH) and all other femoral fractures would be transferred to Queen Elizabeth Hospital (QEH) for fixation. This audit aims to assess the impact of this policy on both patient care and financial impact. Method The inclusion criteria were patients >65 with a femoral fracture. We collected data on 50 patients’ pre-merger (2017) that presented to QEH and compared this to patients presenting in 2022 to QEH (30 patients) and BHH (28 patients) (post-merger). The main data points for comparison were TTS, length of stay (LOS) and 90-day mortality. Results In the pre-merger group, 22(48%) of patients had a TTS ≤36 hours. In the post-merger groups, 15(50%) QEH vs 2(7%) BHH patients had a TTS ≤36 hours. There was no statistical significance when comparing the pre-merger TTS with post-merger QEH (p=0.61); however, there was statistical significance when comparing: TTS QEH vs BHH (p=0.00034) and LOS QEH vs BHH (mean 15 vs 21 days, p=0.0092). There was a trend but no significance between mortality (13% QEH Vs 21% BHH, P=0.41). Conclusions This data demonstrated longer TTS and LOS for patients presenting to BHH. This not only could result in worse morbidity/mortality for patients but also has a financial impact on missed tariffs/penalties and hospital bed costs.