Orthogeriatric treatment and care benefits both patients and professionals: A focus group study.

1) Introduction:

For decades, hospitals have been ‘vertically’ organised, with the risk that specialization leads to fragmented and one-sided views of patient care and treatment which again may cause poor communication and coordination of care and treatment (1-3). Lately, initiatives have proliferated in the attempt to diminish the gap between health specialties and professionals and to ensure quality in patient treatment and patient-perceived quality (4, 5).
Elderly patients admitted with fragility fractures often suffer from multiple comorbidities and a high risk of developing medical complications postoperatively (6).Thus, patients with fragility fractures often need treatment and care form more than one medical specialty are therefore exposed to the risk of poor communication and poor coordination in the vertically organized hospital. To address these challenges, orthogeriatric care was developed as a model of collaboration between geriatricians, orthopaedic surgeons, and an interprofessional team of nurses, therapists, and further relevant healthcare professionals. The introduction of Orthogeriatric care aims at improving quality in patient care as for example reducing mortality, postoperative complications and readmissions as well as improving patients’ mobility (7). In addition, organisational quality can be visualised by assessing healthcare professionals’ perspectives. Two years after the introduction of an orthogeriatric unit, we studied the involved healthcare professionals’ perspectives and experiences with working in an interprofessional organization.

2) Methods:

We performed three focus groups interviews with a total of 16 healthcare workers representing the professions working in the orthogeriatric unit (orthopaedic surgeons, geriatricians, nurses, healthcare assistants, physiotherapists and occupational therapists). Furthermore, a focus group interview with nurses who had subsequently left the ward was performed.
The interviews were analysed using systematic text condensation (STC).

3) Results:

All informants experienced that orthogeriatric care improved treatment quality in elderly patients admitted with hip fractures, and the reason given was that orthogeriatric care addressed all issues relevant to the patients’ well-being.
Additionally, three themes were identified: 1) A patient-centred approach, 2) An opportunity for professional growth and 3) The benefits of interprofessional collaboration. The interviewees emphasized that interprofessional collaboration was strongly stimulated by the introduction of orthogeriatric care. In particular, the systematic and frequent face-to-face communication enabled by the interprofessional team meetings was considered essential to their feeling of enhanced collegial solidarity. All groups expressed their respect for other groups’ competences and their vital contributions to good orthogeriatric care. However, the greatest challenge appeared to concern professional satisfaction and growth. Furthermore, heavy workloads were mentioned as a stressor and offhand one of the reasons for leaving the ward.

4) Discussion:

The introduction of orthogeriatric care was seen as an improvement of the quality of treatment by all professionals. Nevertheless, 2 years after the implementation, the orthogeriatric model continued to be challenged. In another similar study, 16 clinical leaders from different disciplines explored collaborative approaches to the implementation of person-centred hip fracture care and demonstrated that interprofessional meetings enhanced interprofessional collaboration (8). Our findings suggest that there is room for improvements when involving staff perspectives. Thus, considerations on how to stimulate professionals working with orthogeriatric care and how to ensure good working conditions – including considerations on the optimal organization of orthogeriatric care for maximum job satisfaction – are relevant.


5) References

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9) Declaration of competing interests

The authors declare that they have no competing interests.