Rural collaborative guideline implementation: Evaluation of a hub and spoke multidisciplinary team model of care for orthogeriatric inpatients – A before and after study of adherence to clinical practice guidelines

Objective To evaluate whether adherence to orthogeriatric inpatient clinical practice guidelines increased after the implementation of an innovative hub and spoke multidisciplinary team, the S ub‐ A cute C are T eam ( SCT ). Design This study used a before and after design and describes a medical record audit. Setting Rural inpatient facilities with 20–50 inpatient beds. Participants Inpatients aged 65 years and older who sustained a lower limb fracture from a fall were admitted to a regional facility and subsequent rural facility. The audit included 42 inpatients admitted before the SCT ( A pril 2009– A pril 2010) and 35 inpatients admitted after the SCT ( A pril 2011– A pril 2012). Interventions The SCT used interprofessional collaborative practice and orthogeriatric clinical practice guidelines to inform inpatient care. Main outcome measure(s) Adherence was measured by answering 10 questions representative of the guidelines. Chi‐square or F isher's exact tests were used for each question to identify if the proportion of inpatients receiving guideline‐based care changed significantly after SCT implementation. Results After SCT implementation, an increase in the adherence to guidelines was statistically significant ( P <  0.05) for handover, nutrition support, falls prevention, bladder management and more than five guideline‐based care questions. Conclusions Adherence to orthogeriatric inpatient clinical practice guidelines increased after the implementation of the SCT . The mechanisms likely to have contributed include the comprehensive multidisciplinary handover and the opportunity for rural inpatient clinical follow‐up. This model is likely to be effective in improving care for other frail rural inpatient populations.