The orthogeriatric unit for acute patients: A new model of care that improves efficiency in the management of patients with hip fracture

Abstract

We performed a prospective, quasi-experimental, randomised, interventional study comparing two models of care for patients admitted with osteoporotic hip fractures between February and August 2007 in a tertiary university hospital. The usual model of care was treatment of patients admitted to the orthopaedics ward, with consultation by the geriatrician (CG model). The study model involved admission to an acute orthogeriatric unit (OGU model), with joint care provided by geriatricians and orthopaedic surgeons which included immediate geriatric assessment, coordinated daily clinical care, weekly combined ward rounds, and joint planning of the surgical schedule, initial mobilisation, discharge date and destination. No differences were found between CG patients (123) and OGU patients (101) in terms of previous characteristics, number of patients surgically treated, functional level obtained, or discharge destination. OGU patients had earlier geriatric assessment (median 1 day, P25-P75: 1-2) than CG patients (median 4 days, P25-P75: 3-8), earlier surgery (median 5 days from admission to OGU, P25-P75: 3-6, versus 6 days in the CG group, P25-P75: 5-9), and had a shorter acute hospital stay (33% reduction, median 12 days in OGU, P25-P75: 9-14, versus 18 days, P25-P75: 13-23 in the CG group) and total (acute and subacute) hospital stay (30% reduction, median 14 days in OGU, P25-P75: 10-31, versus 20 days, P25-P75: 14-30 in the CG group). All these comparisons were statistically significant (p<0.01). The organization of an OGU in a tertiary hospital allowed hip fracture patients to receive earlier geriatric assessment and surgical treatment. Acute hospital stay was reduced by 33%, and total hospital stay was reduced by 30% with no differences at discharge in clinical and functional outcomes.

Does a Multidisciplinary Team Decrease Complications in Male Patients With Hip Fractures?

“…Previous studies on comanaged models of care for patients with hip fractures report conflicting findings with regard to length of acute hospitalization. González-Montalvo et al [9] and Friedman et al [5] have both shown reductions in length of stay in separate studies, while Khan et al [13] and Fisher et al [4] have separately shown no difference in the length of stay with comanaged units. While length of hospitalization is certainly important to evaluate, the impact of comanagement may be most apparent in the quality of care given to patients.…”

Complications and Their Risk Factors following Hip Fracture Surgery

“…A joint orthogeriatric unit may reduce the delays to surgery and length of hospitalisation. 31 Such co-managed care leads to earlier surgery, fewer complications, and shorter length of hospital stay. 32 Delays for nonmedical reason can be due to the lack of resources (operating theatres, equipment, and staff) and the time needed by the patients and family before consenting to surgery.…”

Orthogeriatrics in the management of frail older patients with a fragility fracture

“…A 2010 quasi-randomised study in Spain compared a joint orthogeriatric model of care with a reactive consultation model [21]. A joint model of care reduced the inpatient length of stay by 33 %.…”

“…Randomised controlled trials examining the effect of orthogeriatric management in patients with a hip fracture have demonstrated reduced mortality rates [20] as well as institutional cost savings from reduced length of inpatient stay [21]. This narrative review will evaluate the role of orthogeriatrics in the management of frail elderly patients with fragility fractures and the evidence base that supports it.…”