Title : Standardizing clerking practice: An orthopaedic audit of hip fracture proforma compliance
Abstract:
Background: With an aging population increasing demand on healthcare, standardization is crucial to ensure equitable and safe care. Clerking proformas in hip fracture management facilitate comprehensive assessment, reducing clinical errors, and optimizing outcomes (1). However, poor compliance undermines these benefits and risks patient safety. (2) This closed-loop audit evaluated adherence to a standardized hip fracture clerking proforma against national guidelines.
Methods: We reviewed forty consecutive hip fracture clerking proformas over three months, assessing completion of twenty-two mandatory sections. Incomplete or incorrectly completed sections were marked as non-compliant. Following identified deficiencies, we delivered a dedicated teaching session during junior doctor induction and displayed educational posters across the department. A month following the intervention, we re-audited the data. Forty further proformas over another three-month period using the same criteria.
Results: Initial analysis revealed documentation gaps: fracture lateralization recorded in only 82.5% and orthogeriatric reviews in only 2.5% of cases. Post-intervention there was a mean increase in completion rate of 17.5% (range 7.5–60%). On analysing the data, we used a Wilcoxon signed rank test to assess the significance of the non-parametric data. Which demonstrated a p<0.05 meaning post-intervention scores were significantly higher than pre-training, demonstrating a meaningful improvement in completion.
Conclusions: Clerking proformas are vital for standardized hip fracture care but depend on correct use. Targeted education at induction significantly enhanced compliance across multiple domains. Embedding proforma training in induction programmes is a cost-effective strategy to sustain high-quality care and should be adopted as best practice in orthopaedic departments.
