Guidelines or state civil codes in the management of femoral neck fracture? An analysis of the reality of care provision in North Rhine-Westphalia.

Introduction: This study analyzes healthcare management patterns in the German Federal State of North Rhine-Westphalia, with regard to time-to-surgery and operative technique in the management of femoral neck fracture.

Methods: Analysis of external quality assurance data relating to inpatient episodes of femoral neck fracture for North Rhine-Westphalia in the years 2004 and 2005. The study included data on 19 767 patients.

Results: More than half of patients receive surgery within 24 hours of hospital admission. Large regional differences exist in relation to the type and timing of surgery. Day of the week is a key determinant of the timing of surgery. Even younger patients, in whom the hip joint should be preserved, receive delayed surgery in some regions.

Discussion: Structured dialog with individual hospitals revealed the following causes for the differences in care provision: guideline recommendations and the recommendations of the Federal Office for Quality Assurance ltd. (Bundesgeschäftsstelle Qualitätssicherung, BQS GmbH), are not accepted as the basis for practice in all quarters; in some areas the necessary staff to ensure timely surgery are lacking. This situation cannot be defended to a wider public, given the clear indications from international literature that a short time to surgery reduces postoperative mortality as well as the incidence of key complications, such as pressure sores, thromboembolisms and pneumonia.