Background: Emerging evidence suggests that early weight bearing is safe and effective in elderly patients, although in practice non-weight bearing (NWB) orders are often made. The aim of this project was to determine effectiveness and feasibility of introducing a NWB coordinator within Alfred Health.
Methods: Patients admitted under General Medicine between June and December 2023 with a fracture were reviewed retrospectively. Following this, a four-week prospective audit was undertaken by a senior orthopaedic physiotherapist of all patients with a fracture managed under a non-orthopaedic/trauma bed-card. Patients considered appropriate for an alteration of WB status were discussed with a consultant surgeon. The number of changes to WB status and the patient’s short-term outcomes was reviewed.
Results: 140 patients in a 6-month period were admitted under General Medicine with a fracture, with a median (IQR) LOS of 6 (3-10) days and only half were discharged home, including those with isolated upper limb fractures (21/43 discharged home). 88 patients were admitted with fractures under non-orthopaedic/trauma units in a Feb/March 2024 (4-week period). A senior orthopaedic physiotherapist facilitated a progression of orthopaedic care for 13 patients. Potential savings per patient ranged from 18 to 56 subacute/transitional care bed-days, with a conservatively estimated accumulative total of 261 bed-days
Conclusion: Introducing a NWB coordinator may increase bed capacity by modifying the orders of some NWB patients. This role may improve access to best care throughout the hospital journey for all patients admitted with a fracture regardless of bed-card.