Defining optimal orthogeriatric hip fracture care: a delphi consensus approach

Development of consensus-based recommendations on core and optimal elements of orthogeriatric hip-fracture care.

An online Delphi survey was performed in the Netherlands. A total of 72 statements were derived from a framework encompassing all phases of care for older patients with a hip fracture. These statements were presented to the panelists in two rounds to identify elements for minimal and optimal orthogeriatric care. Panelists included professionals with experience in hip-fracture care and patient representatives. The level of agreement was measured using a 5-point Likert scale. Consensus was considered if > 75% of the panelists agreed or disagreed.

Ninety-two persons were invited to participate in the survey; 63 participated in the first round and 55 in the second round. One statement was added in the second round. Most participants had a background in geriatrics (36% in the second round) or trauma surgery/orthopaedics (20% in the second round). Consensus was reached on 48 statements for minimal orthogeriatric care and 60 statements for optimal orthogeriatric care.

This study supports previously established recommendations for older adults with hip fractures. In addition, it offers practical recommendations for implementation of orthogeriatric care regarding both core and optimal care elements for hospitals at every different level of maturity and at every step in the care process. This may decrease the intra- and inter-hospital variability of clinical management of hip-fracture patients. Organizational and logistical elements present a barrier to overcoming the gap between the current practice and the optimal situation.