Authors (including presenting author) :
CY Siu (1), Teresa Yu (1) Eric MP Yeung (1), TH Lee (1) Raymond Chin (2), William Cheng (2), KB Lee (2), Wilson Li (2), Pui Kin Ng (3) Pui Pui Lau (3), Ida Ho (3) Rosanna Chau (4), Eddy Cheung (4) , Bobby Ng (5), Jess To (5) Kwai Hing Ting (1)
Affiliation :
(1) Department of Rehabilitation, Kowloon Hospital, (2) Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, (3) Department of Respiratory Medicine, Kowloon Hospital, (4) Physiotherapy Department, Kowloon Hospital, (5) Occupational Therapy Department, Kowloon Hospital.
Introduction :
Osteoporotic hip fracture is an increasing burden to the health care system due to the aging population in Hong Kong. Cross specialist collaboration care is proved to have beneficial effect on clinical outcome on these patients. We attempted to tailor made a new Ortho-Geriatric Collaboration (OGC) service, with cross specialty cooperation, in multi-discipline approach, to improve the care of geriatric osteoporotic hip fracture cases.
Objectives :
To build up a simple and sustainable model to enhance collaboration between Orthopedic and Rehabilitation Department in management of geriatric fracture hip patients To provide proactive and coordinated rehabilitation care to meet need of the frail elderly fracture patients as well as improving quality of care in term of various key performance index
Methodology :
In Kowloon Hospital, orthopedic rehabilitation wards are governed by orthopedic colleagues, and medical problems were managed by reactive medical consultation in the past. This approach might cause potential delay in patient care. After an one-year OGC pilot program – implemented in one orthopedic ward from October 2018 to September 2019, full OGC program was implemented since October 2019. All 3 orthopedic wards (Total 95 beds) were covered. Geriatrician would see all geriatric fracture hip cases more than 60-year-old proactively during regular morning rounds, providing comprehensive geriatric assessment, medical problems management, rehabilitation coordination, complications prevention, osteoporosis management and discharge planning. Geriatric hip fracture patients managed by OGC program and were discharged during October 2019 to September 2020 were recruited (Study group). Geriatric hip fracture patients discharged from July 2017 to September 2018, before the implementation of OGC were served as control (Control group). Demographic and outcomes data were compared between the groups.
Result & Outcome :
We recruited 468 cases in the study group and 446 cases in the control group. For demographic data, the mean age of the study and control group was 84.9 and 83.3 respectively. Female proportion was 67.9% in the study group and 71.5% in the control group. Old age home resident proportion was 18.2% in the study group and 13.7% in the control group. There were no significant differences of age, gender and residence between the two groups. For the outcomes data, the mean length of stay (LOS) was shortened by 5.7 days (18%) in the study group, reduced from 32.3 days in the control group to 26.6 days in the study group, with statistically significant difference (95% CI 3.21-7.84 p< 0.005). Rate of transfer back to acute hospital showed no significant difference. Transfer back rate was 11% (53 out of 468 discharge cases) in the study group vs 9.4% (42 out of 446 discharge cases) in the study group, with no statistically significant difference. Moreover, for the study group, 52% of the cases were given antiresorptive agents or referred to outpatient clinic for osteoporosis management. Conclusion: Ortho-Geriatric Collaboration (OGC) program in Kowloon Hospital statistical significantly shortened the length of stay of Geriatric fracture hip cases by 18% (5.7days). The use of antiresorptive agents for osteoporosis in fracture hip cases were also promoted with high coverage
