© Springer International Publishing Switzerland 2017Paolo Falaschi and David R. Marsh (eds.)OrthogeriatricsPractical Issues in Geriatrics10.1007/978-3-319-43249-6_11
11. Multi Professional Team: Coordination and Communication
University College London, London, UK
David R. Marsh
The various chapters of this book make it clear that many disciplines have important contributions to make to high-quality care for elderly fracture patients. However, their involvement alone does not guarantee success. We say “many hands make light work”, but we can also say “too many cooks spoil the broth”; there is plenty of scope for confusion and inefficient use of precious resources. Obviously, the key to efficient multidisciplinary working has to be coordination and communication between the various players. How can this be achieved in a fracture unit that is attempting to adopt an orthogeriatric approach?
There are many guidelines from countries all round the world that describe how the various players in multidisciplinary teams looking after fragility fracture patients can best coordinate their efforts. An up-to-date catalogue of these can be reviewed on the Fragility Fracture Network website  (select a region and then choose the Fragility Fracture Care Guidelines option). The Geriatric Fracture Center model developed in the USA was fully described in 2014 in a comprehensive publication , which advocates standardised order sets – slightly more specific than the guidelines and protocols more typical in Europe.
Whichever approach is taken, implementation in a particular fracture unit requires agreement, embodied in some sort of handbook or memorandum of understanding that is endorsed by the leaders of the various disciplines in that hospital. The UK National Hip Fracture Database website has a resources section , which includes a model orthogeriatric handbook for an individual hospital and also contains:
suggested job plans for orthogeriatricians and specialist nurses in orthogeriatrics
links to publications describing different models of orthogeriatric care
model business cases and links to publications demonstrating cost-effectiveness
11.1 The Steering Group
Within a hospital, the process often starts with representatives from each clinical area and discipline getting together to form a steering group that reviews the whole pathway for elderly fracture patients. Once the collaborative arrangements have been agreed and disseminated among all the relevant colleagues, it is important that the steering group continue to have regular meetings, which combine discussion of strategy, quality improvement work and clinical governance.
In practice, the initiation and leadership of such a steering group requires the existence of just a few champions – people who have realised how much better and more cost-effective the multidisciplinary approach can be, especially for hip fracture patients, which are the most numerous and costly patient group. They may be orthopaedic surgeons, geriatricians, anaesthetists, nurses – anyone involved in hip fracture care in fact – who are activists, determined to change the way things are done in their hospital. The Fragility Fracture Network exists precisely to generate and develop such champions, by linking them with like-minded people from all over the world.
Although the steering group itself needs to be kept to a manageable size in order to have efficient meetings, it is important that wider audiences be engaged on an occasional basis, to raise the general level of knowledge and commitment among all the healthcare workers involved in fragility fracture care. If the fracture unit opts to take part in a hip fracture database, as described in Chap. 1, then discussion of the data in regular unit meetings (clinical audit, mortality and morbidity reviews etc.) is the ideal way to achieve this.