Enhancing our elderly orthopaedic service

This year, the Trust has been enhancing its specialist service which helps care for elderly patients with bone injuries.

Although there are similar services elsewhere, we are one of the few Trusts that has an orthogeriatric team of physicians who jointly manage our orthopaedic patients with the surgeons. These patients are admitted in an emergency, often after a fall or accident. The team cares for these patients from the moment they arrive at our hospital until their recovery and return home.

Our orthogeriatricians works with both our medicine for the elderly and orthopaedic teams to ensure that the specialist care these older patients need is in place.

Leader of the team and orthogeriatrician Dr Michael Fertleman said: “For example, if the patient has fallen, we would look at why they fell and whether we can stop this from happening again. While the orthopaedic specialist cares for their bones, we assess their entire wellbeing: whether they have an infection somewhere, or perhaps heart problems. We also think about their memory and whether they have any other health conditions which need to be monitored and treated.”

And this year, the service has been extended to elderly patients who have been admitted for elective, non-emergency orthopaedic surgery. Dr Faye Wilson, a specialist registrar, has spent the past year setting up a research project looking into why older patients sometimes become confused after surgery.

“Alongside the surgeon and anaesthetist, we fully assess these patients before their surgery,” Dr Wilson said. “There may be undiagnosed medical conditions present so we consider whether the surgery might be too risky for their health and if there are non-surgical alternatives.”

This year, Dr Fertleman’s team has also been rolling out the national enhanced recovery programme, which aims to improve patients’ recovery from surgery with a variety of techniques. These include shortening the length of time patients are prevented from eating and drinking, cutting the wait in hospital for surgery, assessing the pain relief given and considering changing it to avoid side effects.

Without an orthogeriatrician, elderly patients would be under the care of the orthopaedic specialist alone, who would refer the patient to an elderly medicine specialist only after an age-related problem or complication develops.

The orthogeriatrician’s role is to pre-empt these problems, working proactively as soon as the patient is admitted, to ensure complications are anticipated and the patient’s care tailored in response.

The benefits of this service mean that elderly patients are more likely to receive the treatments most appropriate to all of their conditions, rather than just the symptoms for which they were admitted. It leads to patients having a shorter stay in hospital and recovering more quickly and fully.

“I think the team makes a real difference to the way these patients’ care is delivered. Patients and their families are very satisfied with the service because they get home more quickly and in better shape,” added Dr Fertleman.

Case study
Great-grandfather of three Jerrold Assersohn, 95, benefited from our orthogeriatric service after he fell and broke his hip last autumn.

He said: “I was walking with a stick, put it down on the ground and felt it slide. I looked down and saw I had put it on a bundle of wet leaves.

“I knew I was going to fall – I am used to falling as I used to ride young horses and teach them to jump. I relaxed into the fall but I broke my hip.”

Mr Assersohn was taken to St Mary’s Hospital where he was x-rayed and underwent surgery to replace his broken hip joint. He was cared for by Dr Fertleman and his team to ensure his needs as an elderly fracture patient were met.

“My recovery went very well,” Mr Assersohn added. “I was really impressed with the medical attention and had the minimum of discomfort while I was in hospital and after I came out.

“Now I have completed my rehabilitation and am walking again with a frame. I hope to be using just a stick again soon.”