Betwixt and between: a surgical post-acute treatment unit (SPA) for the optimal care of elderly patients with isolated hip fractures

Abstract

Background A performance improved project identified elderly trauma patients to have a disproportionate incidence of complications. Aims The purpose of this study was to assess the efficacy of a small specialty care unit to decrease complications in patients who no longer warrant care in an intensive care unit (ICU). Methods A surgical post-acute treatment unit (SPA) was developed with focused attention to cognition, nutrition, respiration, and mobilization needs of patients who no longer had physiologic need for an intensive care unit environment, but were still in need of increased attention at the bedside. Results While ICU and hospital lengths of stay were unchanged, patients placed in the SPA experienced less complications and required less unplanned ICU re-admissions. Discussion Geriatric patients, especially the elderly, are not simply old adults. They have unique needs as a consequence of the aging process, which can be encompassed by four pillars of intercession: cognition, nutrition, respiration, and mobilization. Conclusions By adapting a physical environment supported by bedside attention to address the interwoven needs of geriatric and elderly patients who no longer care in an ICU, complications and unplanned return admissions to the ICU can be decreased. Level of evidence III.

The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center

“…Moreover, this was also shown for perioperative care by multidisciplinary teams [20]. The focused care appears to improve outcomes even in patients requiring intensive care [20,21].…”

“…According to previous studies, the development of Geriatric Trauma Centres showed beneficial effects on outcome after hip fractures [19]. Moreover, this was also shown for perioperative care by multidisciplinary teams [20]. The focused care appears to improve outcomes even in patients requiring intensive care [20,21].…”

Exploring geriatric trauma unit experiences through patients’ eyes: a qualitative study

“…Addressing the care needs of older patients with fallinduced injuries is intricately challenging due to the intertwined comorbidities and diminished physiological reserves associated with aging, complicating both surgical interventions and postoperative recovery [5][6][7][8][9]. In response, various treatment models of orthogeriatric care have been developed in the last decade to better serve the complex healthcare requirements of this demographic [10,11].…”

“…In response, various treatment models of orthogeriatric care have been developed in the last decade to better serve the complex healthcare requirements of this demographic [10,11]. Comanaged care, where surgical and geriatric expertise converge within specialized units, has been most effective in enhancing patient outcomes [7,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Although comanaged care has been implemented under various names [5, 7-10, 12, 13, 17, 19-37] worldwide, its fundamental aim remains consistent: optimizing patient outcomes and improving quality of life.…”