Title : A clinical audit of compliance with boast standards for post-operative weight-bearing documentation in hip fracture patients
Abstract:
Background/Aim: Early mobilisation after hip fracture surgery has shown to reduce morbidity and mortality. The 2024 British Orthopaedic Association Standards for Trauma guidance recommended immediate mobilisation unless contraindicated and requires documentation using standardised terminology: non-weight bearing, limited weight-bearing, and unrestricted weight-bearing. This audit assessed compliance with BOAST standards for post-operative weight-bearing documentation.
Methods: We conducted a single-centre retrospective review of patients undergoing hip fracture surgery over 12 months, identified via the National Hip Fracture Database. Operative, post-operative, and physiotherapy notes were analysed to assess compliance of documented weight-bearing terminology with updated BOAST guidance.
Results: 466 operations were identified from the National Hip Fracture Database. Post-operative weight-bearing status was documented in all cases. Full weight bearing (FWB} was recorded in 381 patients (81.8%), weight bearing as tolerated (WBAT) in 31 (6.7%), and unrestricted weight bearing in 49 (10.5%). In four cases (0.9%), weight-bearing status was documented only in physiotherapy notes. Restricted weight bearing was rare: three patients (0.6%) were prescribed partial weight bearing and two (0.4%) toe-touch weight bearing for six weeks, all following fixation with cannulated hip screws.
Conclusion: This study highlights the importance of standardised terminology for post-operative weight-bearing status in accordance with the updated BOAST guidelines. Post-operative management after hip fracture surgery largely aligns with BOAST recommendations favouring unrestricted weight bearing; however, documentation remains inconsistent due to non-standard terminology and variable recording practices. We propose standardising operative note templates to include approved WB terminology which represents a pragmatic, low-cost intervention to improve multidisciplinary communication and patient safety.
