White P1, ten Hove R2
1Chartered Society of Physiotherapy, Practice Unit, London, United Kingdom, 2The Chartered Society of Physiotherapy, London, United Kingdom
Background: Hip Fracture is the commonest reason for people over 60 to require surgery and anaesthesia in the UK. Recovery from this injury poses challenges for both patients and the teams providing rehabilitation. Previous research in UK has shown wide variations in care.
Purpose: There is no data about rehabilitation following hip fracture. Clear pathways of care are essential to ensure safe and effective care, continuity of treatment and rehabilitation planning. To identify the current range of models and pathways of care that people with hip fracture experience in English and Welsh National Health Service (NHS) settings.
Methods: Data set created to capture physiotherapy rehabilitation provision. Existing NHFD network used to identify physio' working in acute centres. These physio's identified others in the pathway. Voluntary semi-structured observational information collected from physiotherapists using iCSP Purposive sampling used to identify services for in-depth exploratory case studies using structured telephone interview or direct site visits. Data collected between May-August 2017.
Results: 580 physiotherapists recruited to the study. Datasets on 7000 people receiving care following a hip fracture was collected. 9 semi-structured service submissions, 3 in depth case studies and 3 visits which covered England and Wales.
Care pathways are either a two-stage process including hospital and home, or a three-stage process including hospital, intermediate care and home. Pathways are simple in compact geographical areas with limited 'catchment' areas of people with hip fracture, and where the acute centre provides and/or co-ordinates all care before discharge home. Pathways are more complicated where the acute hospital serves a large geographical area, and links with a series of community and intermediate services that provide sandwich care between acute care and home care.
Care Models are dependent on local service configuration and innovation. Care Models are clinically focussed around the nature of the injury (orthopaedic), or population focussed around a descriptor of the person (elderly care), or patient-centered around the needs of person with hip fracture as a whole (orthogeriatric), or capacity-based around the resource of the acute unit (outlier).
Conclusion(s): Orthogeriatric care within either a two- or three-stage pathway of care is the recognised optimal level of care for hip fracture rehabilitation. Wide variation in models of care exists dependent on local service arrangements. Wide variations in pathways of care exist dependent on local and regional health service structure. This study highlights the need for further work around local governance and quality improvement to decrease the variation in hip fracture physiotherapy rehabilitation.
Implications: Wide variation in care across the whole period of recovery from hip fracture mean that an indivual person's experience of hip fracture rehabilitation can depend on where they live as well as what their clinical needs and personal circumstances are. Physiotherapists working in hip fracture care need to consider a whole-pathway approach to hip fracture rehabilitation to ensure that optimal rehabilitation is not interrupted as a [person moves through the pathway.
Physiotherapists need to embed with local hip fracture rehabilitation quality improvement teams to ensure local activity is aimed as delivering the optimal model of care.
Keywords: hip fracture, rehabilitation, older people
Funding acknowledgements: The Hip Sprint Project was funded by the CSP.
Purpose: There is no data about rehabilitation following hip fracture. Clear pathways of care are essential to ensure safe and effective care, continuity of treatment and rehabilitation planning. To identify the current range of models and pathways of care that people with hip fracture experience in English and Welsh National Health Service (NHS) settings.
Methods: Data set created to capture physiotherapy rehabilitation provision. Existing NHFD network used to identify physio' working in acute centres. These physio's identified others in the pathway. Voluntary semi-structured observational information collected from physiotherapists using iCSP Purposive sampling used to identify services for in-depth exploratory case studies using structured telephone interview or direct site visits. Data collected between May-August 2017.
Results: 580 physiotherapists recruited to the study. Datasets on 7000 people receiving care following a hip fracture was collected. 9 semi-structured service submissions, 3 in depth case studies and 3 visits which covered England and Wales.
Care pathways are either a two-stage process including hospital and home, or a three-stage process including hospital, intermediate care and home. Pathways are simple in compact geographical areas with limited 'catchment' areas of people with hip fracture, and where the acute centre provides and/or co-ordinates all care before discharge home. Pathways are more complicated where the acute hospital serves a large geographical area, and links with a series of community and intermediate services that provide sandwich care between acute care and home care.
Care Models are dependent on local service configuration and innovation. Care Models are clinically focussed around the nature of the injury (orthopaedic), or population focussed around a descriptor of the person (elderly care), or patient-centered around the needs of person with hip fracture as a whole (orthogeriatric), or capacity-based around the resource of the acute unit (outlier).
Conclusion(s): Orthogeriatric care within either a two- or three-stage pathway of care is the recognised optimal level of care for hip fracture rehabilitation. Wide variation in models of care exists dependent on local service arrangements. Wide variations in pathways of care exist dependent on local and regional health service structure. This study highlights the need for further work around local governance and quality improvement to decrease the variation in hip fracture physiotherapy rehabilitation.
Implications: Wide variation in care across the whole period of recovery from hip fracture mean that an indivual person's experience of hip fracture rehabilitation can depend on where they live as well as what their clinical needs and personal circumstances are. Physiotherapists working in hip fracture care need to consider a whole-pathway approach to hip fracture rehabilitation to ensure that optimal rehabilitation is not interrupted as a [person moves through the pathway.
Physiotherapists need to embed with local hip fracture rehabilitation quality improvement teams to ensure local activity is aimed as delivering the optimal model of care.
Keywords: hip fracture, rehabilitation, older people
Funding acknowledgements: The Hip Sprint Project was funded by the CSP.
Topic: Orthopaedics; Older people
Ethics approval required: No
Institution: Royal College of Physicians
Ethics committee: Royal College of Physicians
Reason not required: The audit was covered under Section 60 of The Health and Social Care Act.
All authors, affiliations and abstracts have been published as submitted.
