Trauma in older people leads to substantial morbidity and mortality. The National Hip Fracture Database (NHFD) has driven improved practice with units compared to identify outliers. In 2013, our unit was an outlier for mortality post hip fracture (30-day mortality 12.2% vs. 8.3% nationally). This triggered external review. In 2019 the unit was highlighted as an exemplar in the UK. We describe the process that moved us from outlier to outstanding. After the initial review process, we made changes to our healthcare system, with regular reassessment of progress and care quality. Examples include a dedicated hip fracture unit, strong leadership (Nursing, Orthopaedic, Geriatrician, Anaesthetic), consultant-led in-depth monthly mortality reviews, changes to admission pathways and delirium prevention. Improvements were seen in all aspects of hip fracture care in 2019 compared with 2012. Thirty-day case-mixed adjusted mortality halved (12.2–6.1%), with substantial reductions in reoperations and pressure sores. Length of stay reduced by 5.9 days. In 2019 our unit’s performance was significantly above the national average for all six indicators assessed by NHFD: prompt orthogeriatric review (97% vs. 91% national average), prompt surgery (85% vs. 68%); NICE compliant surgery (85% vs. 74%); prompt mobilisation (93% vs. 81%); not delirious postoperatively (77% vs. 69%); return to original residence (78% vs. 71%). The NHFD highlighted our Unit as one of nine (from 175 total) highly performing UK trusts. We summarise our service development and improvement work undertaken to achieve ‘outstanding’ status, which provides a valuable template to units managing trauma in older people.

中文翻译：

---

老年人的创伤护理：绘制一条从异常值到卓越的路径

老年人的创伤会导致大量的发病率和死亡率。与识别异常值相比，国家髋部骨折数据库 (NHFD) 推动了改进的实践。2013 年，我们单位的髋部骨折后死亡率异常（30 天死亡率为 12.2%，全国为 8.3%）。这引发了外部审查。2019 年，该单位被列为英国的典范。我们描述了使我们从异类变为杰出的过程。在初步审查过程之后，我们对我们的医疗保健系统进行了更改，定期重新评估进展和护理质量。示例包括专门的髋部骨折部门、强有力的领导（护理、骨科、老年病学、麻醉）、顾问领导的每月死亡率深入审查、入院途径的改变和精神错乱预防。与 2012 年相比，2019 年髋部骨折护理的各个方面都有所改善。30 天病例混合调整后死亡率减半 (12.2-6.1%)，再次手术和压疮的发生率大幅下降。停留时间减少了 5.9 天。2019 年，我们单位在 NHFD 评估的所有六项指标上的表现均显着高于全国平均水平：及时骨科复查（97% 对全国平均水平 91%）、及时手术（85% 对 68%）；符合 NICE 标准的手术（85% 对 74%）；及时动员（93% 对 81%）；术后没有神志不清（77% 对 69%）；返回原住所（78% 对 71%）。NHFD 强调我们的部门是九个（总共 175 个）表现出色的英国信托之一。我们总结了为达到“优秀”状态而进行的服务开发和改进工作，