‘Golden Hip Award’ for top-performing Te Whatu Ora fracture service

A holistic model of care is paying dividends for hip fracture patients at Te Whatu Ora-Health New Zealand’s North Shore Hospital which has just been presented with a Golden Hip Award by the Australian & New Zealand Hip Fracture Registry (ANZFHR) for the second year in a row.

The award recognises North Shore as the top-performing hospital in the country when it comes to the care and management of people with fractured hips.

Orthogeriatrician Dr Min Yee Seow, who is pictured receiving the award on behalf of the hospital, established its fracture care service in 2018 and has liaised with colleagues at other Te Whatu Ora hospitals across the country on the sharing of resources to provide a similar model of care.

One of those hospitals, Hutt Valley, was named as ‘most improved’ at this year’s awards ceremony held on 7 September in Wellington.

Dr Seow works closely with nursing, Emergency Department, anaesthetic and orthopaedic staff to get people into surgery as quickly as possible – optimising the 24-hour window between injury and treatment that ultimately contributes to best outcomes for patients, most of whom are aged 80 and over.

The challenges are tenfold. Most patients are frail with underlying cognitive impairment and are malnourished upon admission. Many are taking multiple medications – including anticoagulation medicines that increase the risk of bleeding intraoperatively.

Dr Seow works with other teams to overcome these and other barriers that might have once delayed a patient’s progression to theatre. An example is the anticoagulation reversal pathway established with Haematology input to ensure anticoagulants don’t delay access to theatre.

“We see the highest number of hip fractures in the North Island at around 400-a-year,” Dr Seow says. “That is due to the large number of older people who live in our area. Seventy per cent of these people would die without surgery within a year, so it is important to follow a model of care that makes sure they receive the appropriate care as quickly as possible.”

North Shore also places a strong focus on postoperative care, rehabilitation and a safe and swift return of patients to their home environment, with the support required for an ongoing recovery.
Prevention is another key consideration.

“Many of our patients have osteoporosis that has contributed to their broken hip,” Dr Seow says. “This is one area where we can make a difference by ensuring that they have the appropriate bone protection medications administered prior to discharge. Our ward pharmacists and Fracture Liaison Service work very closely to ensure that appropriate bone medications are given.

Entries for the Golden Hip Award are measure against seven clinical care standards – care at presentation, pain management, orthogeriatric model of care, timing of surgery, mobilisations and weight-bearing, minimising risk of another fracture and transition from hospital care.

“It is very much a team effort and it is great to have our orthopaedic, emergency, anaesthetic and nursing and allied health departments supporting us in our efforts to meet these standards,” Dr Seow says.