The effectiveness of geriatrician-led comprehensive hip fracture collaborative care in a new acute hip unit based in a general hospital setting in the UK

Abstract

Background: We introduced a new model of care for patients with hip fractures involving a multidisciplinary approach. We then assessed the impact of this geriatrician-led comprehensive and collaborative hip fracture care on hip fracture outcomes.

Methods: The traditional model of care comprised of patients being managed on an orthopaedic ward under the care of one of ten orthopaedic surgeons, with a weekly orthogeriatric liaison. In this study model, hip fracture patients were directly admitted from the emergency department to a new, acute, dedicated hip unit that provided joint patient care by orthopaedic surgeons and an orthogeriatrics team. Intervention measures included fast track admission, a preoperative geriatric assessment, daily geriatrician-led clinical care on weekdays and general medical support on weekends. Standard protocols were implemented. Weekly geriatrician-led multidisciplinary meetings were held with an emphasis on early mobilisation and early discharge planning.

Results: There was a significant reduction in the time to surgery performed within 48 hours (86% vs 77% p=0.013) and in the hospital length of stay (34 vs 19.6 days p<0.001).

Conclusions: The main reasons for the improved outcomes in the study could include the multidisciplinary teamworking with geriatrician-led pre and post-operative care, and working closely with orthopaedic surgeons. Additionally, implementation of systematic protocols could have contributed to positive results.

Keywords: Hip fracture; acute hip unit; orthogeriatrician.