Beyond the Theatre: Improving FY1 Delivery of Holistic Orthogeriatric Care Through Structured Induction

Introduction

Orthopaedic trauma care is a key setting for acute geriatric inpatient management. Foundation Year One (FY1) doctors on orthopaedic rotations predominantly provide ward-based care, with surgical workload analyses showing that resident doctors spend most clinical time on prescribing, multimorbidity optimisation, and discharge coordination rather than senior-led operative decision-making.

In this setting, FY1 doctors are responsible for the day-to-day delivery of core orthogeriatric care, including analgesia optimisation, delirium prevention, early mobilisation, fluid management, and secondary fracture prevention. National Hip Fracture Database (NHFD) and NICE guidance emphasise that these processes are central to improving outcomes in this high-risk population.

However, FY1 preparedness to deliver these principles is limited, and orthopaedic induction often prioritises surgical knowledge over the practical delivery of inpatient geriatric care, highlighting a gap between training needs and induction content.

Method

A service evaluation assessed FY1 self-reported confidence in key orthogeriatric domains before and after a structured induction guide. Pre-intervention data were collected from two FY1 cohorts and post-intervention from one cohort. With input from the pharmacist and  an orthogeriatric Advanced Nurse Practitioner the resource aligns with NHFD standards and safe prescribing guidance. Domains included pain, opioid safety, post-operative nausea and constipation, IV fluids, and bone health. Responses were categorised as low, neutral, or high confidence.

Results

Pre-intervention, FY1 confidence was lowest in opioid safety, constipation prevention, and fluid prescribing across orthogeriatric domains. Following implementation, confidence shifted towards neutral and high across most domains, with partial improvement in IV fluid prescribing. More complex areas, including osteoporosis work-up and bisphosphonate decision-making, showed limited change.

Conclusion

FY1 doctors on orthopaedic rotations deliver inpatient care underpinned by orthogeriatric principles rather than surgical decision-making. A structured multidisciplinary induction provided practical tools and signposting to support independent delivery of holistic fragility fracture care, and may improve consistency of care in this high-risk population.