Orthogeriatric Services (OGS) have been established to improve the quality and efficiency of care for patients presenting with hip fractures. The Australian and New Zealand Society for Geriatric Medicine Position Statement on Orthogeriatric Care provided detailed guidance on best practice throughout the pre-, peri- and post-operative phases of care for older fracture patients admitted to hospital. A key focus was the concept of early multidisciplinary coordinated care to reduce in-hospital mortality and medical complications, and to improve functional outcomes. An integrated approach to post-fracture osteoporosis management and falls interventions was also advocated.
The new trans-Tasman acute hip fracture care guidelines were published in September 2014. These guidelines – in combination with the New Zealand Hip Fracture Registry, which is in development – will provide a basis for benchmarking of hip fracture care delivered by hospitals throughout New Zealand and Australia.
OGS have been shown to dramatically improve post-hip fracture rates of osteoporosis treatment at hospitals in Auckland and Christchurch:
- Auckland City Hospital
– Auckland City Hospital’s ortho-geriatric service: an audit of patients aged over 65 with fractured neck of femur. NZ Med J. 2011 Jun 24;124(1337):40-54. PubMed ID 21946877
- Middlemore Hospital
– Timely delivery of hip fracture care: a Middlemore Hospital audit. NZ Med J. 2013 Oct 18;126(1384):77-83. PubMed ID 24162632
– Secondary prophylaxis of osteoporotic fractures in an orthogeriatric service. Aust J Ageing. 2011 Mar;30(1):41. PubMed ID 21395941
- Christchurch Hospital
– Older patients with hip fractures: evaluation of a long-term specialist orthopaedic medicine service in their outcomes. NZ Med J. 2007 May 18;120(1254):U2535. PubMed ID 17515939
– Shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures. NZ Med J. 2005 May 6;118(1214):U1438. PubMed ID 15886733
Leading OGS and hip fracture registry initiatives
- Australia and New Zealand Hip Fracture Registry: Australian and New Zealand facilities level audit published 2013 – link.Trans-Tasman acute hip fracture care guidelines were published in September 2014. Hip fracture registry information technology platform developed in Q3-2014. Pilot sites currently collecting data in Australia and to start in New Zealand in Q4-2014. http://anzhfr.org/
- Fragility Fracture Network: The Fragility Fracture Network (FFN) is leading a major drive to promote globally the optimal multidisciplinary management of the patients with a fragility fracture, including secondary prevention. In July 2014, the FFN launched a major new web resource at http://fragilityfracturenetwork.org/.
Orthogeriatrics Services and Fracture Liaison Services
The National Bone Health Alliance (NBHA) in the United States has clearly described the respective priorities for Orthogeriatrics Services (OGS) and Fracture Liaison Services (FLS) in the delivery of a systematic approach to hip fracture care and prevention in the United States. This description is likely to be applicable in other countries.
‘OGS focus on delivering professional standards of acute care for patients suffering hip fractures, which includes appropriate discharge planning, including osteoporosis and fall prevention measures. FLS focus on delivering secondary preventive assessment for patients presenting with fractures caused by osteoporosis at any skeletal site. In units with an established OGS, a FLS program could extend provision of secondary preventive care to those individuals suffering fractures that are managed in the outpatient fracture clinic setting, and for any patients admitted to hospital on account of a fracture at a site other than the hip, should this patient group fall outside of the scope of the OGC program.’