Orthogeriatric collaboration and 24-hour medical support to reduce unplanned readmission of orthopaedic patients

• Published in: Asian journal of gerontology and geriatrics Vol. 15; no. 2; p. 97
• Main Authors: Chan, T C, Cheng, K C A, Ng, T, Chiu, K C P, Chan, H W F
• Format: Journal Article
• Language: English
• Published: Hong Kong Hong Kong Academy of Medicine 01.12.2020
• Subjects: Collaboration; Continuity of care; Fractures; Geriatrics; Older people; Orthopedics; Patient admissions; Prevention
• ISSN: 1819-1576; 1819-1576

Introduction: Most patients with fragility fracture, especially hip fracture, have multiple comorbidities and are frail. In Hong Kong West Cluster, most of these patients are transferred to Fung Yiu King Hospital/ MacLehose Medical Rehabilitation Centre (FYKH/ MMRC) for rehabilitation after initial acute management in Queen Mary Hospital (QMH). Owing to the high vulnerability, these patients are prone to short- and long-term complications. A multidisciplinary approach is essential to improve patient outcome. Before October 2017, there was no on-site orthopaedic doctor support for FYKH/MMRC in-patients after office hour. QMH orthopaedic on-call doctor would be called upon, and some patients may be transferred to QMH for assessment and management. Since October 2017, two programmes have been launched in FYKH/MMRC: orthogeriatric collaboration in management of geriatric fragility fractures by both orthopaedic surgeons and geriatrician, and 24-hour medical support from medical and geriatric doctors to orthopaedic in-patients. When orthopaedic inpatients have any medical deterioration in FYKH/MMRC, orthopaedic surgeons will consult FYKH medical and geriatric doctors for timely medical support. We aimed to determine the effectiveness of orthogeriatric collaboration and 24-hour medical support on reducing unplanned readmission in orthopaedic in-patients in FYKH/MMRC. Methods: Records of orthopaedic in-patients between October 2016 and September 2019 were reviewed. Data collected included the number of orthopaedic in-patients transferred from QMH to FYKH/MMRC and the number, percentage, and reasons of unplanned readmission from FYKH/MMRC to QMH in three periods: period 1 (October 2016 to September 2017, one year before implementation of the programme), period 2 (October 2017 to September 2018), and period 3 (October 2018 to September 2019). Results: Respectively in periods 1, 2, and 3, the number of orthopaedic in-patients transferred from QMH to FYKH/MMRC was 1446, 1606, and 1537; the number of unplanned orthopaedic readmission from FYKH/MMRC to QMH was 148, 129, and 82; the percentage of unplanned readmission from FYKH/MMRC to QMH was 10.2%, 8.0%, and 5.3% (trend test: p<0.001). Conclusion: Orthogeriatric collaboration and 24-hour medical support from the medical and geriatric doctors in FYKH successfully reduced unplanned readmission of orthopaedic patients from FYKH/MMRC to QMH.