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Age Ageing. 2016 April; 45(Suppl 1): i4.
Published online 2016 April 4. doi:  10.1093/ageing/afw024.16
PMCID: PMC4890374

16
INNOVATION ON THE ORTHOPAEDIC UNIT: EVALUATION OF A NEW ORTHOGERIATRIC SERVICE

Background Orthogeriatricians aim to optimise the care of older patients undergoing orthopaedic surgery and direct postoperative enablement, thus reducing hospital stay and improving functional outcomes. There was expansion and redesign of the service at Salford Royal Foundation Trust in August 2013 and the newly established orthogeriatric team implemented several interventions to improve quality of care and reduce length of stay for trauma patients.

Intervention The new service included increase in the orthogeriatric consultant staff from a 0.5FTE to 2.5FTE, consolidating the service with the orthogeriatric specialist nurse.

Interventions included:

  •  8am trauma MDT with the orthogeriatrician, anaesthetist and orthopaedic surgeon of the day to optimise trauma patients and reduce potential delays.
  •  Daily MDT board round to facilitate discharges and prioritise patients for review.
  •  Structured admission clerking templates for trauma patients.
  •  Proactive communication with patients and relatives.

Improvement We analysed data looking at length of stay, percentage of preoperative medical reviews and quality of admission clerking. Online surveys were distributed to orthopaedic, anaesthetic, medical, allied health professionals and nursing staff with an overwhelmingly positive response to the interventions.

YearAverage length of stay (All trauma admissions)Number of trauma admissions
August 2012–20138.971227
August 2013–20146.831550

Time periodHip fracture Preoperative review %
April 2012– April 201346.6% (116/249)
April 2013– April 2014 (Service redesign)68.7% (195/284)
April 2014– April 201577% (227/295)

Pre template introductionPost template introduction
No. of clerking standards achieving > 80% compliance (n = 117)8/2117/21

Discussion Key improvements to the measures associated with the quality of care of older adults have been demonstrated with additional benefits to patient flow in all trauma patients discussed at the daily MDT board round. The changes have received positive feedback from the MDT who interact with the orthogeriatric service and can easily be adopted by other orthopaedic units.


Articles from Age and Ageing are provided here courtesy of Oxford University Press