A Pilot Program of Ortho-Geriatric Collaboration (OGC) Service in Kowloon Hospital

Abstract Description

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Authors (including presenting author) :

TH Lee (1), Teresa Yu (1) Eric MP Yeung (1), Raymond Chin (2), Rosanna Chau (4), William Cheng (2), Pui Pui Lau (3), KB Lee (2), Wilson Li (2), Olga Ma (3), Pui Kin Ng (3), Bobby Ng (5), Kwai Hing Ting (1)

Affiliation :

(1) Department of Rehabilitation, Kowloon Hospital, (2) Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, (3) Department of Respiratory Medicine, Kowloon Hospital, (4) Physiotherapy Department, Kowloon Hospital, (5) Occupational Therapy Department, Kowloon Hospital.

Introduction :

Osteoporotic hip fracture is an increasing burden to the health care system due to the aging population in Hong Kong. Cross specialist collaboration care is proved to have beneficial effect on clinical outcome on these patients. Each hospital has its own situation and culture; we attempted to tailor made a new Ortho-Geriatric Collaboration (OGC) pathway to suit needs of our hospital

Objectives :

• Built up a simple and sustainable model to enhance collaboration between Orthopedic and Rehabilitation Department in management of geriatric fracture hip patients • To provide proactive and coordinated rehabilitation care to meet need of the frail older fracture patients as well as improving quality of care in term of various key performance index

Methodology :

In Kowloon Hospital, orthopedic rehabilitation wards are governed by orthopedic colleagues, and medical problems were managed by reactive medical consultation. This approach might cause potential delay in patient care. In order to provide a more proactive medical service, a new OGC program was started on 4th October 2018, which recruited all fracture hip patient aged more than 60-year-old in one pilot orthopedic ward, physician will provide twice weekly regular morning ward rounds and provide suggestions, particularly focused on issues related to fracture hip rehabilitation. Case conference and family conference will be held in selected cases with discharge issues. Our program is characterized by the following points: - Because of limited manpower, the rehabilitation team can only provide 8 hours of consultation per week; we prioritize our time on patients with active medical problems or potential discharge problems. - Comprehensive templated assessment in electronic version facilitating communication between specialties and multi-disciplines - Avoid increased front-line workload by minimizing unnecessary clerical work - Achieve continuation of patient care through our rehabilitation day lounge or osteoporosis clinic after patient discharge from hospital

Result & Outcome :

The programme was retrospectively evaluated to compare two periods under pre and post OGC service, During a 12- week period, forty hip fracture patients were recruited to the pilot program (n = 40). Another forty concessive cases who admitted before the program initiation were reviewed for outcome comparison. Patients aged from 70 to 98 years old with a mean age of 84.4 ± 7.9 years old. The mean Charlson Comorbidity Index (CCI) was 4.5, the mean Abbreviated Mental Test (AMT) score of the patients was 5.8 out of 10. The baseline characteristics were similar in both groups of patients. The mean length of stay (LOC) of patients reduced from 32.0 days to 24.0 days after program implementation (p = 0.04). Before the OGC program, seven patients required unplanned transfer back to acute hospital (n = 7, 17.9%), while only four patients after OGC program (n = 4, 10.0%, p = 0.34). The usages of anti-osteoporosis medication were the same in both groups (n = 8, 20%). In the OGC program group, the physical function in term of mean Functional Independent Measure (FIM) and Elderly Mobility Scale (EMS) increased by 7.9 and 3.4 respectively. The percentages of patients returned back to their original caring place (both residential and non-residential care) were similar in both groups of patients (70% vs. 72% in patients with or without OGC program respectively). One patient died within 30 days post discharge in the non-OGC program group, while no patient in the OGC group. Conclusion The new OGC program aims at providing more proactive medical support for the fracture hip patients since many of them are frail and have multiple comorbidities. It seems that after the program implementation, there is some improvement in the LOS of patients; the need of urgent transfer back to the acute hospital tended to decrease, although the further data analysis is necessary to confirm this observation. The discharge to original destination rate was maintained, and the patients also had significant functional improvement. Further outcome analysis and continue team building will be necessary to refine the program to suit the needs of both departments