Improving outcomes for frail older adults with upper limb fractures

Background: Frail older adults presenting with upper limb fractures are a vulnerable cohort within acute care. Although these injuries are usually managed conservatively, they frequently result in avoidable admissions and prolonged hospital stays. Unlike hip fracture pathways, there is no standardised orthogeriatric model for this group. This project aimed to reduce avoidable admissions and reduce length of stay by integrating early frailty intervention into existing orthopaedic pathways.

Methods: Process mapping of the patient journey from Emergency Department (ED) presentation to discharge identified the absence of a consistent pathway and key points for intervention. A redesigned pathway was implemented over a 16-week period, introducing routine frailty screening for ED patients referred to Orthopaedics. In parallel, an automated alert system was developed with the Business Intelligence team to notify the frailty service of all patients aged over 65 years admitted with upper limb fractures, ensuring timely inpatient review where same-day assessment was not possible.

Results: Following implementation, all frail patients who met eligibility criteria were reviewed by the frailty team within 48 hours of injury. Assessments included Comprehensive Geriatric Assessment, evaluation of mobility and function, and early discharge planning. Same-day discharge rates improved from 28% to 63%, while mean length of stay reduced from 9.5 to 4.9 days. This equates to approximately 566 bed days saved annually, with an estimated cost saving of £155,595 per year. The project achieved a 0% 30‑day hospital readmission rate.

Conclusion: Proactive identification of frailty and early geriatric input for older adults with upper limb fractures significantly improves patient flow and outcomes while delivering substantial operational benefits. Embedding frailty expertise within orthopaedic pathways can reduce length of stay, enhance discharge planning, and generate meaningful cost savings. This project demonstrates that relatively small service changes can lead to sustained improvements in care quality and system efficiency.