Orthopaedic Surgery

All hip fracture and TKR patients should receive a multidisciplinary assessment pre-operatively to determine achievable goals of rehabilitation.

For TKR patients, pre-operative care should include: education, post operative protocol, identifying patients at risk of a poor functional outcome and organisation of rehabilitation equipment at home.

More intense rehabilitation in the hospital immediately after hip fracture surgery, focusing not just on improving mobility, but on strength, balance and endurance.

Properly funded and designed seven day services to ensure consistent quality of care in terms of intensity and frequency of rehabilitation across the whole week.

There should be changes to the culture and layout of wards to ensure all staff are involved in encouraging patients' mobility and independence, providing opportunities for them to get active.

Hip fracture patients should be discharged from acute care as soon as they are medically fit, to continue their rehabilitation in the most suitable environment (without a break).

There should be clearer identification of who is responsible for coordinating the discharge and continued care of the patient, to ensure there are no gaps in the rehabilitation - either by extending the ortho geriatrician role, or creating a new post that bridges acute and community health and social care.

Community rehabilitation services should be adequately resourced to provide early, intense and frequent rehabilitation to all hip fracture patients.

All TKR patients should have follow up with a specialist physiotherapist within three weeks post discharge to assess post operative progress. The majority will not require routine post operative rehabilitation.

Community physiotherapy services should divert resources away from TKR rehabilitation to focus more on hip fracture patients.

Rehabilitation data should be routinely collected in the NHFD and the NJR to monitor patient across the whole pathway.