International Recognition of O&T Elderly Fragility Fracture Service in Tseung Kwan O Hospital

Abstract Description

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Authors (including presenting author) :

Cheung WLP(1), Chan SP(1), Ng K(1), Lee YL (1)

Affiliation :

(1) Department of Orthopaedics & Traumatology, Tseung Kwan O Hospital

Introduction :

Aging population increases the number of elderly suffering from a fragility fracture in their lifetime because of osteoporosis. More than twenty percent of them would sustain a second and subsequent fracture if bone health interventions are not given after the first fracture. By responding to the first fracture, a coordinated service and intervention is evidenced to optimize their bone health throughout life and prevent further fractures. Although the fragility liaisons service has not been piloted in TKOH, nearly 1000 patients were admitted because of fragility fractures in 2017. With an aim to fill this service gap of secondary fracture prevention and promote bone health, the fragility fracture service was implemented in September 2017.

Objectives :

1. To provide coordinated bone health interventions and secondary fracture prevention for elderly with fragility fractures. 2. To launch clinical services meeting international standard in a cost effective manner. 3. To provide education and monitoring on lifestyle modification, diet advice and medication compliance for optimizing bone health. 4. To empower patients with fall prevention strategies. 5. To early identify osteoporosis patients to provide primary fracture prevention.

Methodology :

1. The fragility fracture service delivery model in TKOH closely follows The Best Practice Framework of “Capture the Fracture”, an internationally endorsed guideline for secondary prevention of osteoporotic fractures. It is structured as a series of thirteen standards. 2. A multi-disciplinary pathway on fragility fracture was devised. 3. A designated bone health nurse was assigned to provide bone health services for indicated patients. 4. Participation in community projects to promote bone health and fall prevention.

Result & Outcome :

1. From Sep 2017 to Nov 2018, total 817 cases were served. 2. 29 % of them started bone health medication. 3. Medication compliance rate was 100%. 4. Fall incident rate was 4% 5. Re-admission rate because of fall incident was 0.2% 6. Secondary fracture rate was 0.2% 7. The Capture the Fracture Steering Committee evaluated the achievement of hospitals against the Best Practice Framework. TKOH is one of three hospitals in Hong Kong receiving such recognition. TKOH was also awarded “Bronze Level Criteria of the Capture the Fracture Programme” in November 2018 and is the only hospital in Hong Kong which could achieve all their five stars. Conclusion Elderly fragility fracture service in TKOH has attained outstanding international standard without designated resources. It could effectively and efficiently enhance care quality and decrease inpatient services demand.