OPTIMISING MEDICAL CARE FOR HIP FRACTURE PATIENTS WITH AN ORTHOGERIATRIC TEAM: A 2 YEAR PROSPECTIVE AUDIT FROM A DISTRICT GENERAL HOSPITAL.

Abstract

Objectives: To determine the effect of an Orthogeriatric team (OGT) upon patient management pre-operatively after its incorporation into a regional trauma centre of a district general hospital in the UK.

Design: Prospective audit covering all patients admitted with a fractured hip for surgery one year before and one year after the establishment of an OGT.

Method: A total of 288 fractured hips were operated on during February 2004 to February 2005. From February 2005 the OGT was created, consisting of a Staff Grade and 2 Senior House Officers (junior residents), assisted part-time by a consultant. Patients were medically managed and optimised for theatre; 301 patients underwent surgery in the 1st year from Feb 2005 to 2006.

The data was collected prospectively from admission, and entered onto a database.

Results: Before the set up of the OGT only one-quarter (25%) of patients were operated on within 24hours compared to almost one-half of patients (44%) under the care of the OGT. Of the patients waiting more than 24hours, delay while waiting for special tests was similar but there was a significant difference in the percentages of patients delayed due to lack of theatre time and poor medical condition. Only 5% of patients under the care of the OGT were delayed due to medical co-morbidity compared with 44% when solely under orthopaedic care.

Conclusion: Focused high-quality medical input provided by a specialist Orthogeriatric team resulted in significantly reduced delays to theatre for patients admitted with a fractured hip. This is in the context of our hip fracture population becoming increasingly frail with increasing medical problems and continuing pressures on operating time. In the environment of financial constraint, this study confirms that reduction in time to theatre, effective, appropriate investigation and lower complication rates are likely offset the cost of the team. This may provide a model for other units.