Case study: orthogeriatric service, Limerick, Ireland
This orthogeriatric service supported hip fracture patients while they were in hospital and facilitated access to essential post-fracture care.1 The services were highly effective and led to cost savings. Thanks in part to the success of this programme, University Hospital Limerick is considered a leader for the development of orthogeriatric services in Ireland.2
What does the programme involve?
An orthogeriatric service was implemented at University Hospital Limerick in 2011 as a collaboration between geriatrics and orthopaedic surgery.1 People who were admitted to the hospital with a fragility hip fracture received a comprehensive geriatric assessment before surgery so that any additional conditions could be managed appropriately.1 After surgery, they received bone health and falls assessments and were offered a referral to the hospital’s fracture liaison service.1 While in hospital, hip fracture patients were seen daily by the geriatric team.1
What has the programme achieved?
There were significant improvements following the implementation of this orthogeriatric service:1 3
- There were reductions in the number of days people stayed in hospital, the proportion of people who died within one year of a hip fracture and the number of people who needed further rehabilitation. People who received care through this service were also less likely to be discharged to a long-term care facility.
- The reduced length of hospital stay and reduced need for rehabilitation meant that the cost per hip fracture patient was reduced by over €3,000 compared with before the orthogeriatric service was introduced.
- When all savings are factored in, the annual reduction in healthcare costs amounted to more than €1.4 million, easily offsetting the estimated €171,000 required to implement a full-time service.
What lessons can be learnt from this programme?
The introduction of an orthogeriatric service can significantly improve outcomes for people with hip fractures. In turn, these improved outcomes can lead to considerable cost savings in both acute and long-term care.
The information in this case study is based on research conducted for the 2020 publication Osteoporosis and fragility fractures: a policy toolkit.
- Henderson CY, Shanahan E, Butler A, et al. 2017. Dedicated orthogeriatric service reduces hip fracture mortality. Ir J Med Sci 186(1): 179-84
- National Office of Clinical Audit. Quality improvement focus at the Irish Hip Fracture Meeting 2018. Available from: https://www.noca.ie/news/quality-improvement-focus-at-the-irish-hip-fracture-meeting-2018 [Accessed 01/09/20]
- Shanahan E, Henderson C, Butler A, et al. 2016. Dedicated orthogeriatric service saves the HSE a million Euro. Ir Med J 109(4): 385