Orthogeriatrics service for hip fracture patients in Dunedin Hospital: Achieving standards of hip fracture care

PurposeTo evaluate the orthogeriatrics service (consult liaison provided by geriatricians on an orthopedics ward) for hip fracture patients in Dunedin Hospital and to assess how well standards of hip fracture patient care were achieved. These standards (adapted from British Orthopaedics Association) include admission to ward within 4 hours, surgery within 48 hours, assessment and care to reduce pressure ulcer risk, access to orthogeriatrics services, and secondary prevention of falls and osteoporotic fractures.MethodsThis retrospective audit reviewed patients above age 65 years admitted to the orthopaedic service in Dunedin Public Hospital with a neck of femur fracture between January 1, 2010, and December 31, 2010.ResultsThere were 144 patients with median age of 86 years. 24.5% were admitted to the Orthopaedics ward within 4 hours: 70.8% had surgery within 48 hours and 73.6% had pressure ulcer assessment completed as per our hospital protocol. One-third was seen by the orthogeriatrics team on the day of surgery or earlier. History of falls was not documented in about one third of patients. Only 20.8% had postural blood pressure measured, and 35.6% of those discharged home had a home visit. About 30% did not have documentation of previous fractures, and one-quarter were not assessed for consideration of bisphosphonate therapy. Inpatient mortality was 9%.ConclusionsSeveral areas for improvement were identified from this retrospective study. Suggestions for achieving the standards of hip fracture care are provided. Further audit after implementing these changes is recommended.