Collaborative working to improve the return of patients to their usual place of residence following fractured neck of femur

Summary 

This paper reports on multi-disciplinary and collaborative working that improved the care and outcomes for patients’ following fractured neck of femur (NOF), within the Orthopaedic Directorate in one District General Hospital (DGH) in the United Kingdom (UK). 3389 patients over 8 years formed the purposive sample. The data were gathered and analysed from clinical audit data pertaining to all patients in one DGH admitted with fractured NOF during two time periods over the eight years. Firstly, between 1996 and 2000 data provided evidence consistent with national UK and international challenges in terms of delay in operating on trauma patients as well as large numbers of patients requiring a high level of long term care. In the DGH, the average length of stay had increased from 40 days to 46 days in total in a four year period between 1996 and 2000. In 1996 an average of 14% of patients were discharged to their usual place of residence, increasing to 27% by the year 2000. However, like the national picture this trend impacted on the length of hospital stay, increasing it by 6 days over a 4 year period to 46 days. The second sample period between 2001 and 2004 reflected changes in working practice impacting on length of stay and patient destination. It demonstrated an overall decline in the length of stay as well as an increase in the percentage of patients discharged to their usual place of residence from 21% in 2001 to 43% in 2004. Care of this group of patients was managed within a focused multi-disciplinary team that included a trauma co-ordinator and ortho-geriatrician.

This paper demonstrates how patient focused, collaborative care management enabled more patients’ to return to their usual place of residence following fractured neck of femur. The findings add to the evidence and debate for constructing efficient and effective multi-professional teams for health care where patients are placed at the centre of care (National Service Framework for Older People (Department of Health. 2001. National Service Frameworks for Older People. London)).

Keywords: Fractured neck of femur, Length of stay, Multi-disciplinary, Patient focused, Discharge