Implementing an Orthogeriatric Multidisciplinary Team Grand Round to Improve Multidisciplinary Care for Older Trauma patients

Introduction

Older adults admitted with femoral fragility fractures require coordinated multidisciplinary team (MDT) approach. On a 33-bed orthopaedic trauma ward with predominantly older people with frailty, MDT identified systemic challenges causing prolonged length of stay and suboptimal patient experience. Key issues included fragmented MDT processes, duplication between board rounds and ward reviews, delays in investigations and decision-making, inconsistent communication with patients and families, and frequent outlying of patients to other wards. Although national guidance emphasises early orthogeriatric input, early therapy intervention and effective MDT working, implementation remains variable.

Methods

In February 2025, the MDT designed and implemented a weekly ortho‑geriatric bedside grand round. Although consultant‑led, the model was driven by MDT. Core participants were ortho-geriatric consultant and registrar, ward manager, senior physiotherapist, senior trauma nurse, pharmacist. All femoral fracture patients and selected older people with frailty admitted with trauma were reviewed.

The round provided a single structured MDT discussion at the bedside, reducing duplication, enabling early identification of barriers to recovery. Standardised discussion focused on medical optimisation, medication review, postural blood pressure, bowel and bladder care, rehabilitation goals, discharge planning, and patient and family communication. A mid-point MDT review informed iterative refinements to attendance, timing, preparation, documentation, patient engagement, and ward environment.

Results

Following implementation, the MDT reported improved compliance with key elements of comprehensive geriatric care, including postural blood pressure measurement, weight monitoring, bowel, bladder management. Improved MDT communication and collaboration helped enabling earlier identification and resolution of barriers to recovery. Interactive MDT discussion enabled rapid resolution of concerns and improved decision‑making. Patients and families participated in decision making. A reduction in length of stay and outlier number was observed.

Conclusion

A structured, consultant-led and MDT‑driven ortho‑geriatric grand round can improve patient outcome. Ongoing evaluation will assess patient, family and staff experience, sustainability, and potential for wider organisational adoption.