An Innovative Approach: Pre-Hospital Hip Fracture Care

On the episode, the Older Persons Emergency Network (OPEN) Clinical Director Dr Elizabeth (EJ) Marsden and OPEN nurse practitioner Sarah Bold share their teams achievements to provide pre-hospital hip fracture care. The OPEN Metro North  team provides a pre-hospital neck of femur fracture pathway as a Queensland Ambulance Service co-response emergency department substitution model to provide timely outreach care for frail older persons living in residential aged care facilities and the community.

Joining us on this episode to revisit and update on the topic of direct oral anticoagulants, or DOACS, and timing of surgery are Dr Hannah Seymour, a consultant geriatrician from Fiona Stanley Hospital in WA and Dr Seth Tarrant an orthopaedic surgeon from John Hunter Hospital NSW. We covered this topic on this Hipcast episode in 2024 with Hannah and Professor Rebecca Mitchell following the results of ANZHFR Sprint Audit and publication of the Fragility Fracture Networks’ consensus statement in the journal Anaesthesia.  We will also be looking at how time to surgery is tracking across AU and NZ and implications of this for practice.

Dr Suzanne Dyer presents on What the Evidence Tells Us in Rehabilitation at the ANZHFR Hipfest 2023. Dr Dyer is a senior research fellow at Flinders University, she’s worked as a researcher in both the public and private sector with expertise in evidence based methodologies including health technology assessment, systematic reviews, meta-analysis and guideline development. She’s the author of over 70 publications and reports including the Cochrane Review on Interventions for Improving Mobility after Hip Fracture.Please find the mentioned research below:- Interventions for improving mobility after hip fracture surgery in adults - 2022 Cochrane Review- Multidisciplinary rehabilitation for older people with hip fractures - 2021 Cochrane Review- Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery - 2015 Cochrane Review

Joining the John Hunter Hospital hip fracture care team on Hipcast to sharing their insights into the multidisciplinary care approach of their site awarded the ANZHFR Australian Golden Hip 2023 Award for top performing hospital. Joining us on the episode:Mrs Ramya Kunnath: Orthopaedic Clinical Nurse Consultant - Hunter New England LHDDr Erica Epstein: Geriatrician - Hunter New England LHDDr Seth Tarrant: Orthopaedic surgeon - Hunter New England LHDProf Zsolt Balogh: Director of Trauma  - Hunter New England LHD 

Professor Kim Delbaere & Dr Rik Dawson share their work on raising awareness for falls prevention nationally. Kim is a Senior Principal Research Scientist at Neuroscience Research Australia and a Professor of Health Sciences at the University of New South Wales. She is the current President of the Australian and New Zealand Falls Prevention Society. Dr Rik Dawson is a Gerontological Physiotherapist and postdoctoral researcher at the Institute for Musculoskeletal Health at the University of Sydney. Rik is the current National President of the Australian Physiotherapy Association. 

A/Prof Danielle Ni Chroinin explores the effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery. Links discussed:1. The effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery: a quality improvement study (2020) in Anaesthesia2. Delirium Reduction by Analgesia Management in Hip Fracture surgery (DRAM-HF): Exploration of perceived facilitators and barriers (2021) in Australasian Journal on Ageing3. Clinical Practice Guideline: Orthogeriatric Hip Fracture Care (2023)

1 in 3 Australians aged 65 and over fall each year making it the leading cause of death for this age group.Rik Dawson, an experienced physiotherapy and researcher, lifts the curtain to explain what is happening in residential care facilities in terms of physiotherapy care and rehabilitation and explores some important issues including: The lack of rehabilitation available in residential aged care facilities;  The massive problem of falls in these facilities;The challenges of providing care and staffing as set by the Aged Care Act 1997 and the impact on coordinated care;Specific areas of focus in physiotherapy and residential aged care that warrant funding for improved quality of life outcomes.

Coming to you live at the 2024 ANZHFR Hipfest in Sydney to hear about how the Registry data is fuelling improvements in hip fracture care across the country. Guests include:- Dr Sheila Rahman, Orthogeriatrician, Campbelltown Hospital (NSW)- Dr Hannah Seymour, Geriatrician, Fiona Stanley Hospital (WA)- Mel Alexander, Intensive Care Paramedic, SA Ambulance Service (SA)

Dr Lara Harvey, a senior research fellow at Neuroscience Research Australia and our ANZHFR co-chair Prof Jacqueline Close, a geriatrician based at Prince of Wales Sydney discuss their newly published research titled “Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015–2018: a retrospective population-based study”.The ACSQHC hip fracture care clinical care standard comprises seven quality statements supported by 16 quality indicators. This study looked at the impact of adherence to these standards on mortality for patients with hip fracture. You can find the full study here in the Medical Journal of Australia.

In this episode, Professor Rebecca Mitchell and Dr Hannah Seymour discuss the work they led in partnership with international colleagues from the Fragility Fracture Network on consensus statements developed to aid clinicians in their decision-making and to reduce practice variations in the management of patients with hip fracture  taking direct oral anticoagulants.For the full article:Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statementhttps://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16226?af=RFor more information on the upcoming ANZHFR Sprint Audit, email [email protected]