Multi-disciplinary care of the patient with acute hip fracture: How to optimise the care for the elderly,traumatised patient at and around the time of the fracture to ensure the best short-term outcome as a foundation for the best long-term outcome

Of the 70,000 patients presenting in the UK each year with hip fracture, most are frail, elderly with multiple co-morbidities and polypharmacy. Falls are often attributed to slips or trips, but many reflect the patient's inability to steady themself because of slowed reflexes, poor balance, underlying musculoskeletal disorders, poor vision and sarcopenia. A proportion of patients fall due to an inter-current medical illness, such as chest or urinary sepsis and others from acute presentation of stroke or cardiac arrhythmia.These patients require a coordinated multidisciplinary approach from the point of admission to the point of discharge. The National Institute for Health and Care Excellence (NICE) Guidance on hip fracture published in 2011 refers to the hip fracture programme [1]. This chapter aims to expand on the concept of the hip fracture programme and how this approach in the acute peri-operative period can ensure the best short-term outcomes as a foundation for the best possible longer-term outcomes.