Role of stakeholders
Role of stakeholders
A feature common to practically all published descriptions of effective orthopaedic-geriatric co-care services is the formation and involvement of a multi-disciplinary team. Accordingly, from the outset of service development, the Champion(s) needs to convene a group comprised of representatives from all the professional groups that have a role to play in the optimal care of fragility fracture patients. The specialities involved are indicated below.
Orthopaedic surgeons and geriatricians
An orthopaedic surgeon and/or a geriatrician is/are likely to champion the development of a new service and will play a leading role in implementation.
Anaesthetists, radiologists, rehabilitation physicians/physiatrists, general physicians/internal medicine doctors/hospitalists, haematologists
All of these specialists are likely to be members of the multidisciplinary team involved in care of hip fracture patients. In jurisdictions where access to geriatricians is limited, general physicians/internal medicine doctors/hospitalists could provide the medical component of the co-care model. Haematologists have an important role to play on account of the issue of pre- and post-operative anaemia.
Lead Clinicians for osteoporosis, falls and dementia
Hip fractures are usually the result of a fall in an individual with compromised bone strength. As such, ensuring patients receive a fracture risk assessment – including both bone health (osteoporosis) and falls risk factors – is a vital component of effective post-fracture care. Furthermore, the prevalence of dementia among this population has been reported to be almost 30%, so the opportunity to undertake cognitive assessment should not be missed. Accordingly, the individuals who serve formally or informally as Lead Clinicians for osteoporosis, falls and dementia in the hospital or health system, and their clinical teams, have a key role to play in the care of hip fracture patients.
Nurses play a vital role in the acute care of hip fracture patients and are an essential part of the multidisciplinary team. An international group of nurse experts have comprehensively examined key aspects of care in the ‘toolkit’ publications below. The first paper considers pain and delirium and the second paper considers pressure ulcers, fluid balance and nutrition, and constipation and catheter associated urinary tract infection.
Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 1). International Journal of Orthopaedic and Trauma Nursing. 2012 Nov;16(4):177-194. Link.
Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2). International Journal of Orthopaedic and Trauma Nursing. 2013 Feb;17(1):4-18. Link.
Allied health professionals
Physiotherapists/physical therapists, occupational therapists, dieticians and nutritionists play an important role in the recovery of hip fracture patients.
Institution management, business development and finance
Gaining management buy-in for development of an orthopaedic-geriatric co-care service is essential. Hospital or health system administrators have a role to play in the development of the business plan and subsequent decisions to fund the service in the short and long-term.
Quality improvement professionals
Hospital or health system quality improvement professionals should be key internal advocates for development and implementation of a service that aims to deliver better hip fracture care and outcomes for patients. Illustrating to these professionals what has been achieved by services elsewhere and how such services feature in national policies in other countries is time well spent.