Care for people with fractures from falls could improve after supplement of studies published

Healthcare for those who suffer fragility fractures will benefit following a special supplement published highlighting innovative approaches.

Under the leadership of Dr Emma Sutton, the special supplement of 12 papers has been published in BMJ Open Quality, in collaboration with the Fragility Fracture Network (FFN), on quality improvement initiatives in healthcare improvement for fragility fracture (fractures caused by a fall from a standing height or less) patients.

The 12 papers came from clinicians and researchers investigating quality improvement innovations in diverse settings in Canada, the Philippines, Norway, Australia and the United Kingdom.

Topics included fragility fracture prevention, new models of care (such as post discharge Advanced Physiotherapy follow up, embedded orthogeriatric consultation in acute orthopaedics), a fragility fracture database set up in a low-to-middle-income country (LMIC), early mobilisation, nutritional care and Fracture Liaison Services.

Dr Emma Sutton, Associate Professor at the University of Birmingham, and Clinical Academic Lead for University Hospitals Birmingham NHS Foundation Trust, said:

“I am so pleased to have been able to lead this collaboration between BMJ Open Quality and the Fragility Fracture Network to publish this important supplement. All of the papers offer valuable insight on a great many important topics and new models of care will certainly be needed to meet the growing demand, whilst taking workforce shortages into account.

I hope this supplement strikes a chord with clinicians, academics and quality improvers who all want to continue to embed learning to make health and social care systems safe and effective for all.”

Team approach to growing problem

The global population of people experiencing fragility fractures is rapidly growing, placing huge burden on health economies, families, and caregivers. The cumulation of work from teams around the world as part of the special supplement highlights challenges and opportunities to improve care for these patients.

The special supplement provided clinical teams with a platform to highlight their learnings and start conversations with others who may encounter similar challenges and opportunities in their work.

As lead of the special supplement, Dr Sutton wrote the opening editorial with Lauren Baupre, President of the Fragility Fracture Network (FFN), and Jack Bell who co leads the FFN Fragility Fracture Recovery Research Special Interest Group with Dr Sutton. The editorial sets the scene for the crucial work outlined in the supplement, and places it in the context of the global mission of the Fragility Fracture Network to enact a call to action to improve care for people with fragility fractures.

Dr Sutton also co-authored one of the papers within this supplement with a team from The Prince Charles Hospital in Queensland, Australia on the role of the advanced physiotherapist in post discharge hip fracture care. It explored incorporating an advanced physiotherapist into post discharge hip fracture care for patients, and the potential benefits it could offer.

The Advanced Physiotherapist model was implemented from October 2020 to January 2023, with 346 patients being seen by an advanced physiotherapist. The project is believed to be the first of its kind globally to show that an advanced physiotherapist model in hip fracture care is cost neutral, as well as having the potential to create more time for surgical registrars.