The Impact of a Multidisciplinary Team on Acute Geriatric Patients After a Femur Fracture

PURPOSE: Falls in the geriatric population can threaten independence and create a financial burden on the health care system. Trauma and hospitalization after a fall can lead to a decline in performance of activities of daily living and functional mobility, future falls, and mortality. Femur fractures are a common injury in the geriatric population, and management guidelines suggest an interdisciplinary approach.

In 2013, the Geriatric Trauma Service (GTS) was formed at Barnes Jewish Hospital, which consisted of a multidisciplinary team that had received specialized training focusing on geriatric physiology, psychosocial implications, cognition, and functional performance. The goal of this team was to streamline and improve the care of geriatric trauma patients. As a result of the development of this team, a specialized occupational therapy (OT) minimal assessment was developed to ensure that the needs of geriatric patients were assessed. The purpose of this study was to describe geriatric trauma patients at an academic medical center who were admitted for a femur fracture after a fall and to determine the impact of a multidisciplinary team specializing in geriatric trauma.

DESIGN: This is a descriptive study in which 200 medical charts of patients 65 yr of age admitted over a 2-yr period with a femur fracture from a fall were retrospectively reviewed. One hundred charts prior to implementation of GTS and 100 charts after implementation were randomly selected.

METHOD: General demographics, comorbidities, preadmission function, fall details, hospital and surgical information, and rehabilitation notes were collected from the medical charts.

RESULTS: Patients’ mean age was 80.4 ± 9.4 yr; 72.5% were female. The following comorbidities were reported: diabetes 27%, cardiac conditions 82%, neuromuscular conditions 26%, osteoarthritis 36%, and cognitive impairment 22%. The reasons for the fall were as follows: 71% fell from standing, 13% fell from sitting, 7% fell on the steps, and 9% had an unwitnessed fall. The majority of patients (95%) required surgical intervention, and most (70%) required at least moderate assistance with mobility tasks. The discharge location was home (4%), home with home health (10%), skilled nursing facility (64%), or acute rehab (22%). After implementation of the multidisciplinary team, there was a significant increase in the utilization of OT services (78% to 95%, p < .05) along with an increased use of a cognitive assessment (36% vs. 74%). Length of stay decreased from 6.3 ± 4.8 to 5.1 ± 2.7 days (p < .05), and there was a trend in mobilizing patients earlier as the number of days from surgery to out of bed decreased from 2.0 ± 2.6 to 1.4 ± 0.7 days (nonsignificant). There were no differences between groups for discharge destination.

CONCLUSION: This study provides a description of geriatric patients hospitalized after a femur fracture along with some of the potential benefits of a multidisciplinary team, such as decreased length of stay, earlier mobilization, and increased utilization of OT services. Incorporating a structured interdisciplinary approach to the care of geriatric patients may lead to positive clinical outcomes and potentially reduce health care costs associated with falls. Future studies evaluating the long-term impact of specialized multidisciplinary teams in the acute setting are needed.

References

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National Institute for Health and Clinical Excellence. (2011). Hip fracture: Management (Publication No. CG124). Retrieved from https://www.nice.org.uk/guidance/cg124/resources/hip-fracture-management-35109449902789

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