ANZHFR Sprint Audits

A Sprint Audit involves additional questions or variables that are temporarily added to the routine registry data collection. Sprint Audits allow us to get a ‘close up’ view of one aspect of care in a short period of time.

Click on the titles below to find a summary of our ANZHFR Sprint Audit projects, findings and recommendations.

Direct Oral Anticoagulant Sprint Audit (2024)

The ANZHFR Direct Oral Anticoagulant Sprint Audit (DOACs)t was undertaken in June-July 2024.

Rationale:

- identify differences in clinical practices for patients pre-operatively taking DOACs across Australia and New Zealand.
- better understand care and health outcomes for hip fracture patients taking DOACs
- serve to inform local and system-wide care enhancement initiatives.

A summary of the audit results can be downloaded and saved HERE

Further analysis is being undertaken by the research team, which will be shared as a peer review publication.

Reference: Mitchell RJ, Wijekulasuriya S, Mayor A, Borges FK, Tonelli AC, Ahn J, Seymour H; Fragility Fracture Network Hip Fracture Audit Special Interest Group. Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statement. Anaesthesia. 2024 Jun;79(6):627-637. doi: 10.1111/anae.16226. Epub 2024 Feb 6. PMID: 38319797.

Preoperative Fasting Sprint Audit (2023)

The ANZHFR Preoperative Fasting Sprint Audit was undertaken in June 2023.

Rationale:
• To highlight current fasting practices and where there are potential gaps in care and opportunities to improve care.
• Data will be used to drive quality improvement activities.
• Reducing fasting times will reduce thirst, hunger, nausea, anxiety, hypoglycaemia and contribution to hospital acquired malnutrition.
• Reducing unnecessary fasting prior to surgery will ultimately improve the patient experience

Summary of the audit results can be downloaded and saved HERE

Prof Jacqui Close (Registry Co-Chair and Geriatrician) and Dr Philip Black (Anaesthetist) have recorded a podcast highlighting the results and discussing the roll out of Sip Til Send at Prince of Wales Hospital https://www.buzzsprout.com/1739857/13839642

Resources for Sip Til Send from Prince of Wales Hospital can be found under Shared Hospital Resources at https://anzhfr.org/resources/

The results and information on the roll-out of the Sip Til Send initiative at Prince of Wales and Sydney/Sydney Eye hospital were also presented at the Binational Hip Fest. The recording can be accessed on the ANZHFR Training and Education You Tube site.

Acute Rehabilitation: ANZHFR Sprint Audit (2022)

Bone Medication Protection: ANZHFR Sprint Audit (2021)

ANZHFR Nutrition Sprint Audit (2021)

Patient Level Results

Background

Malnutrition is the most costly comorbidity in hip fracture and the one most likely to prolong length of stay [1]. It is a stronger predictor of 12-month mortality than ASA grade, Charlson Comorbidity Index, time to surgery, or type of surgery [2]. Malnutrition is observed across all BMI ranges, and in overweight or obese patients is a very strong predictor of 12-month mortality [3]. It has been widely established that multidisciplinary, multimodal nutrition care can improve outcomes [4].

As reported in the ANZHFR Annual Report (2021):

In New Zealand, 46% of patients had an assessment for malnutrition
In Australia, 69% of patients had an assessment for malnutrition
In both countries, a large proportion of patients not assessed suggests malnutrition may be under reported.

The ANZHFR Sprint Audit sought to gain greater insight into the current provision of nutrition care to patients with a hip fracture in Australia and New Zealand.

Audit Population

Thirty hospitals across Australia and New Zealand voluntarily contributed patient-level data to the ANZHFR Sprint Audit on malnutrition. This resulted in a study population of 450 patients with a hip fracture aged 50 years and over admitted to a participating hospital between 1 - 31 August 2021.

Thirty-six hospitals voluntarily contributed facility-level data to the ANZHFR facility-level Nutrition Sprint Audit.

Findings

Nearly 3 in 10 patients were diagnosed with malnutrition, although the proportion of patients not assessed suggests malnutrition remains under-reported