title: The effectiveness of geriatrician-led comprehensive hip fracture collaborative care in a new acute hip unit based in a general hospital setting in the UK.
abstract: BACKGROUND
  We introduced a new model of care for patients with hip fractures involving a multidisciplinary approach. We then assessed the impact of this geriatrician-led comprehensive and collaborative hip fracture care on hip fracture outcomes.
  
  
  METHODS
  The traditional model of care comprised of patients being managed on an orthopaedic ward under the care of one of ten orthopaedic surgeons, with a weekly orthogeriatric liaison. In this study model, hip fracture patients were directly admitted from the emergency department to a new, acute, dedicated hip unit that provided joint patient care by orthopaedic surgeons and an orthogeriatrics team. Intervention measures included fast track admission, a preoperative geriatric assessment, daily geriatrician-led clinical care on weekdays and general medical support on weekends. Standard protocols were implemented. Weekly geriatrician-led multidisciplinary meetings were held with an emphasis on early mobilisation and early discharge planning.
  
  
  RESULTS
  There was a significant reduction in the time to surgery performed within 48 hours (86% vs 77% p=0.013) and in the hospital length of stay (34 vs 19.6 days p<0.001).
  
  
  CONCLUSIONS
  The main reasons for the improved outcomes in the study could include the multidisciplinary teamworking with geriatrician-led pre and post-operative care, and working closely with orthopaedic surgeons. Additionally, implementation of systematic protocols could have contributed to positive results.
authors.affiliation: A Gupta Glangwili Hospital Carmarthen SA31 2AF, UK tel. +44 (0)126 722 7740 e-mail guptaabhaya@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D005260:Female; D005853:Geriatrics / Q000458:organization & administration*; D006299:Health Services for the Aged; D006620:Hip Fractures / Q000628:therapy*; D006757:Hospital Units; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000458:organization & administration; D010348:Patient Care Team; D061665:Time-to-Treatment; D006113:United Kingdom
keywords: Hip fracture; acute hip unit; orthogeriatrician