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RD&E investment in Orthopaedic Trauma service reaps benefits for patients & NHS


Royal Devon & Exeter hospital patients are benefitting from a new approach to orthopaedic services where they receive not only specialist surgical and nursing care after breaking a bone, but also support and treatment to help reduce their risk of falls and broken bones in future.


The RD&E Wonford responds to over 2,000 fragility fractures every year, with around 600 patients admitted to the acute specialist orthopaedic hospital with a fractured hip.


Consultant Orthogeriatrician Dr James Mulcahy said: “In most instances patients of the Princess Elizabeth Orthopaedic Centre think they must have fallen particularly hard to have broken a bone.  Many older patients do not realise that their bones were fragile and so susceptible to breaking easily. Bone health and strength deteriorates as we get older, particularly in women after the menopause. Until recently, acute hospitals tended to focus on repairing the broken bone when someone had been injured in a fall.  However, thanks to a national initiative to improve the care of patients who have fallen or fractured, the hospital has made changes to ward care and follow-up to ensure older frailer patients receive the very best care possible.


“Our patients now have a team of professionals who work together to assess the patient, and to put together a package of treatment, rehabilitation and ongoing health care so they not only recover from the fall but they continue to benefit from care to improve their bone health and to address any issues which may have caused the falls in the first place. 


“For example, patients with hip fractures now have their operation much sooner after arriving in hospital, usually within one day.  All patients have a bone health assessment when they are on the ward, and bone-strengthening treatments are commenced as soon as possible.  Also, our physiotherapists see people earlier and more often during their stay, to help them get back on their feet more quickly.  The therapists also refer our patients to community-based falls teams for ongoing assessment and therapy.”


The Royal Devon & Exeter NHS Foundation Trust has invested in this initiative to provide increased availability of orthopaedic operating theatres and the appointment of two consultant orthogeriatrician doctors in order to make sure the care provided to patients is the very best, with routine input by specialist surgeons, physicians, nurses and therapists.


Phil Luke, RD&E Divisional Manager of Trauma & Orthopaedics, said: “The introduction of a multi-disciplinary team approach to patients who have fractured their hip has had a highly positive impact upon their care. The team comprises of elderly care physicians, pharmacists, physiotherapists, Occupational Therapists, trauma nurse practitioners, surgeons, theatre staff, and nursing staff from Durbin Ward, the RD&E’s trauma ward.


“Through working together with common protocols and daily “board rounds” we have so far doubled the proportion of patients undergoing surgery within 36 hours of admission and reduced the length of hospital stay for our patients from an average of 13.6 to 9.1 days.


“Through increasing access to surgery and rehabilitation the team aims to reduce mortality associated with a fractured hip and improve patients’ recovery, whilst at the same time reducing costs associated with the time a patient is in hospital.


“We are also planning to establish an Early Supported Discharge scheme, which would enable clinically appropriate patients to return home much sooner and receive regular support from healthcare professionals, like nurses and therapists, in their own home.

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