Abstract
Background: Recognising the need for orthogeriatric input for fractured neck of femur patients, as evident from recent studies, has been established fact for some time now. Although, most studies suggest a healthcare model involving an orthogeriatric service of some degree, usually a visiting physician or a post-operative rehabilitation setup, we highlight an innovative strategy involving a dedicated in-house orthogeriatric team providing a high-level of care based in a stabilisation unit. Since the realisation back in 2004 that the Relative Risk for Mortality in patients with fractured neck of femurs was 164.6, CI (130.5–204.8) compared to the expected level of 100, a series of changes were introduced to combat this.
Methods: Within the orthopaedic department a trauma stabilisation unit (TSU) was setup with a dedicated orthogeriatric service and the early warning score (EWS) system was implemented. This was used to identify patients requiring higher levels of care and thus transfer to TSU.
Results: The 2007 Relative Risk for Mortality for hip fractures stands at 92.4, CI (66–125.9) suggesting a reduction of 44% in mortality. Furthermore, there has been no significant change in age, co-morbidity or delay to surgery over this period.
Discussion: The presence of an orthogeriatric service which dedicates itself to patient optimisation pre-operatively and post-operative recovery has immensely improved the outlook on this frail population. The increase level of nursing care with a ratio of 1:2 and implementation of the EWS system again adds to improved patient care and outcome. Thus we strongly advocate that the development of such a care model within trauma & orthopaedics is essential in improving the service our patients receive.
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
