Every older and frail person who suffers a low impact skeletal trauma (fragility fracture) should expect the same high quality of care irrespective of where and when this happens.
We are fortunate in the United Kingdom to have a ‘free-at-point-of-access’ healthcare system (although ‘best practice’ treatment for all patients is not provided by every unit). Other providers might have constraints put on them by private medical insurance companies. That said, the better the quality of pre-, peri- and post-operative care, the better the patient outcome, and therefore cost/benefit to the funding organisation. The quality of care should be governed by the current best practice guidelines, with emphasis on compassion.
In writing this paper, the author acknowledges that some aspects of what patients and their next of kin (or carers) should expect are aspirational: that is, they are aims, rather than certainties. That should not devalue the basic quality of care provided by every funding authority and clinical multi-disciplinary team. Where provision of care falls short of this ideal, steps should be taken to improve the patient care pathway. Following ‘best practice’ has been shown to provide better patient outcomes.
Older and frail patients who suffer low impact skeletal traumas (from a standing height) are very likely to have several other health conditions which might impact on their treatment and recovery. Also, typically, older and frail patients might suffer from sarcopoenia (loss of muscle strength) and anaemia. They might also be confused, and may even be suffering short-term delirium. A patient’s physical and mental health can quickly worsen if they do not get the best possible care. The appropriate experts should assess, treat, and provide aftercare for every patient as quickly as possible. Whilst the multi-disciplinary team is key to the patient’s outcome, they might need to take advice from other clinical experts to help manage a patient’s other conditions. This paper hopes to indicate the ideal for these situations from the patient point of view whilst acknowledging not all organisations will currently have the ability to provide everything.
All patients who suffer a low impact skeletal trauma should expect:
- Rapid access to a hospital with trained trauma staff: To be treated by pre-hospital teams as an emergency.
- Rapid x-ray or 3D diagnosis: e.g. 3D imaging is vital for accurate diagnosis and therefore effective care for pelvic region low impact trauma.
- Rapid access to the operating theatre: Waiting to have surgery is sometimes more risky than having surgery and an anaesthetic for many patients.
- Rapid re-mobilisation: Getting out of bed on the day of the operation, or at the latest the following day and being mobilised improves physical recovery. It also lessens the negative impact on patients’ mental health
All patients should further expect:
- That their treatment is managed by a competent multi-disciplinary team with access to the right kind of medical and surgical specialists, who will help them recover and go back to their place of residence quickly.
- That one of Consultants is the named the lead for their care.
- Seamless liaison between all hospital units, primary care (e.g. GPs and their team), community services and social care.
- That a nominated team member will act as liaison between them (the patient), their nominated relatives/carers, and all other specialists involved in their care and agreed discharge plan.
- That their discharge from hospital to their place of residence should be planned, discussed with them (and/or their next of kin/carer) and agreed by them.
- That they leave hospital with a copy of their rehabilitation prescription , (or discharge plan) in a format and language they can understand.
- The name and contact telephone number of a case manager in the event they need healthcare advice after leaving hospital.
All patients should also expect:
- A referral and date for a post hospital discharge assessment in order to assess their ongoing needs to improve their bone health and work towards preventing another low trauma fracture.
- That they are offered falls prevention support.
- Appropriate on-going community-based support post-discharge, pre-arranged with their primary care practitioner, and social service provider.
- Support for their at-home carer/partner. A live-in partner/carer might also be older and frail.
- That they are given details of any charities that can support them after they leave hospital.