New fast track service for patients with hip fractures

Every year around 700 elderly patients are admitted to the Norfolk and Norwich University Hospital with acute hip fractures. Now they are being fast-tracked from A&E to a new Orthopaedic Medical Unit on Docking Ward, where their care is managed by a multidisciplinary team. The aim is to reduce their length of stay in hospital, while ensuring they have the necessary support in their own communities.

 “A great deal of planning has gone into this project,” says Dr Payne, consultant in Medicine for the Elderly. “We are looking at all aspects of patient care as a total team effort, from diagnosis through surgical treatment to post-operative recovery.  For instance, there may be some underlying medical reason for their trip or fall which needs to be investigated.
 
“Without the new Orthopaedic Medical Unit, these patients would need to spend more than a week in hospital, followed by up to two weeks in a community hospital. But provided there are no other medical problems and the they have the support of their families and professionals in the community, it is much better for these patients to be looked after at home.”

Mudussar Ahmad, trauma Fellow in Orthopaedics, said: “We advise all patients with hip replacements to get back on their feet as soon as possible. Staying in bed can create complications such as chest infections and bed sores and is not the best thing for the patient at all.”

Nurses on the new unit are receiving ongoing training in all aspects of orthopaedic care. They have spent time on Earsham Ward at NNUH and also at Dereham’s former Ashill rehabilitation unit to gain an understanding of rehabilitation work.

The multidisciplinary team includes physiotherapists, pharmacy staff, occupational therapists and the East Anglian ambulance service.

Community Nurse Mark Walker says: “We are planning the patients’ return home right from day one, so the team meets regularly to discuss their progress. If necessary, patients are visited by a therapist on the day they go home to assess the need for aids such as trolleys, support frames and raised toilet seats.”

Sister Jane Douglas, who is leading the nursing team, says “Extra funding has enabled us to provide a unit with a highly skilled team of therapists and a dedicated nursing team. We are lucky to have senior nursing staff with surgical and rehabilitation expertise who can help us adjust to new ways of working. Dr Payne and the orthopaedic team are also on hand every day for clinical support.”

Note to editors

• Every year around 700 patients are admitted to NNUH with acute hip fractures (fractured neck of femur)
• The average age is over 80 and more women than men are affected, reflecting the higher rate of osteoporosis in this age group.
• An important part of the medical work of the new unit is to prescribe anti-osteoporosis drugs to prevent further fractures.
• The Orthopaedic Medical Unit was piloted with just six beds in 2003. The Unit now has 18 beds where patients have the benefit of a fast-track service from A&E, earlier surgery and optimal post operative medical management