Authors (including presenting author) :
Chan TC(1), Cheng KCA(1), Ng T(4), Ng KH(2), Lau TW(3), Chiu KCP(1), Luk KHJ(1), Chan HWF(1)
Affiliation :
(1) Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital (2) Department of Orthopaedics, QMH and TWGHs Fung Yiu King Hospital (3) Department of Orthopaedics, QMH (4) Nursing Department, TWGHs Fung Yiu King Hospital
Introduction :
Most patients with fragility fracture, especially hip fracture, have multiple comorbidities and they are frail. In HKWC, most of these patients, after having initial acute management including timely operation in QMH, are transferred to FYKH/MMRC for rehabilitation. However, due to the high vulnerability, they are prone to short and long term complications.
A multidisciplinary approach with geriatric input is essential to improve patient outcome. Before Oct 2017, there was no on-site doctor support for FYKH/MMRC orthopaedic in-patients after office hour. If there was deterioration in medical condition after office hour, QMH orthopaedic on-call doctor will be called upon and some of these patients may be transferred back to QMH for further assessment and management. Some transferals could be avoided if there was on-site doctor support after office hour.
Since Oct 2017, two programs have been launched in FYKH/MMRC. Firstly, the orthogeriatric collaboration in the management of geriatric fragility fractures. Patients with fragility fracture are co-managed by Orthopaedic surgeons and Geriatrician. Secondly, 24-hour medical support from M&G doctors to orthopaedic in-patients. If there is any medical deterioration of Orthopaedic patients in FYKH/MMRC, orthopaedic surgeons could consult FYKH M&G doctor. The on-call M&G doctor will then provide timely on-site medical support to those patients.
Objectives :
To study the effectiveness of the Orthogeriatric collaboration program and 24-hour medical support to orthopaedic patients in FYKH/MMRC
Methodology :
Orthopaedic in-patient record were reviewed from Oct 2016 to Sep 2019. Data collected include number of orthopaedic patient transferred from QMH to FYKH/MMRC, number of unplanned orthopaedic readmission from FYKH/MMRC to QMH and reason of unplanned readmission. Percentage of patient required unplanned readmission was calculated. Time period are divided to Oct 2016 to Sep 2017 (one year before implementation of the two programs, Period I), Oct 2017 to Sep 2018 (Period II) and Oct 2018 to Sep 2019 (Period III).
Result & Outcome :
Orthopaedic patient transferred from QMH to FYKH/MMRC of Period I, II and III were 1446, 1606 and 1537 respectively. Number of unplanned orthopaedic readmission from FYKH/MMRC to QMH were 148, 129 and 82. Percentage of unplanned readmission from FYKH/MMRC to QMH of Period I, II and III were 10.2%, 8.0% and 5.3% respectively (trend test: p< 0.001).
These findings showed that the Orthogeriatric collaboration program and 24-hour medical support from the Department of M&G in FYKH successfully reduced unplanned readmission of orthopaedic patients from FYKH/MMRC to QMH.
