Comparison of 3 Different Perioperative Care Models for Patients With Hip Fractures Within 1 Health Service

Coventry, Lillian S.; Nguyen, Austin Q.; Karahalios, Amalia; Roshan-Zamir, Sasha; Tran, Phong

doi:10.1177/2151458517692651

Cited by 10 publications

(17 citation statements)

References 15 publications

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“…The presentations section of the event was customized and attended by 20 to 50 team members (orthopedic ward, physicians from the orthopedic, anesthesia, and geriatric departments). Topics selected by a majority of departments were principles of comanaged care (7), preoperative optimization (7), and management of delirium (4). Other topics included were antibiotics, pain, and osteoporosis (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Orthogeriatric co-management improves the outcome of older adults with a fragility fracture and is the gold standard for care with proven outcomes and many published consensus guidelines. 1 - 7 Implementation of a geriatric fracture program has been reported in many settings and various barriers reported. 8 , 9 Successful implementation requires strong physician leadership to articulate both a short- and long-term plan, good communication to implement standardized plans of care working with all members of the healthcare team and to foster relationships both within the hospital and with other institutions in the community.…”

Section: Introductionmentioning

confidence: 99%

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Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult

Gosch

Kammerlander

Fantin

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: Surgeons, internal medicine physicians, nurses, and other members of the healthcare team managing older adults with a fracture all have barriers to attending educational courses, including time away from practice and cost. Our planning group decided to create and evaluate a hospital-based educational event to address, meet, and improve the care of older adults with a fracture. Materials and Methods: A committee of surgeons and geriatricians defined 3 learning objectives to improve knowledge and attitudes in co-managed care. They designed a 1-day educational event consisting of a departmental visit, a review of cases, a planning session to identify gaps and plan changes, and presentations on selected topics. Thirteen hospitals worldwide completed an 8-question online application form, and 7 sites were selected for delivery over 3 years in Denmark, Colombia, Thailand, Paraguay, Switzerland, and the Dominican Republic. Results: Each event was conducted by 1 or more visiting surgeons and geriatricians, and the local team leaders. The most common challenges reported in the applications were preoperative assessment or optimization, delayed surgery, lack of protocols, access to a geriatrician, teamwork, and specific aspects of perioperative and postoperative care. In each department, 4 or 5 goals and targets for implementation were agreed. The presentations section was customized and attended by 20 to 50 team members. Discussion: Topics selected by a majority of departments were principles of co-managed care (7), preoperative optimization (7), and management of delirium (4). Follow up was conducted after 3 and 12 months to review the degree of achievement of each planned change and to identify any barriers to complete implementation. Conclusions: Hospital-based events with visiting and local faculty were effective to engage a broader audience that might not attend external courses. A performance improvement component with goal setting and follow up was acceptable to all host departments.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult

Gosch

Kammerlander

Fantin

et al. 2021

Geriatr Orthop Surg Rehabil

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“…Nevertheless, the changes did not significantly impact mortality or complication rates during the hospital stay or after a 3-month follow-up. While detecting medical problems and preventing complications is one of the main tasks of the geriatrician in an orthogeriatric setting, Coventry et al [30] showed higher complication rates after involvement of a geriatrician. This increase is explained by a better detection of complications.…”

Section: Discussionmentioning

confidence: 99%

Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference?

Werner

Krause

Macke

et al. 2020

BMC Musculoskelet Disord

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Background Proximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previous studies have focused on relatively comprehensive care models. Models with only a few additions to the usual care have not been extensively evaluated. Methods This retrospective observational study included all patients aged ≥70 years (mean age: 84.5 ± 7.1 years, 70% women) with an isolated proximal femoral fracture treated surgically in our institution from May 2018 to October 2019. In the first 9 months, patients were treated with the usual care (control group, n = 103). In the second 9 months, patients were treated with our multidisciplinary care model (intervention group, n = 104), which included the usual care, plus: (1) one multidisciplinary ward round per week and (2) one “elective” operation slot per day reserved for proximal femoral fractures. Baseline characteristics and outcome measures of the hospital stay were extracted from electronic health records. A 3-month follow-up was conducted by phone. Results Baseline characteristics were comparable between groups (p > 0.05). The hospital stay was shorter in the intervention group than in the control group (7.8 ± 4.3 vs. 9.1 ± 4.5; p = 0.022). The intervention reduced the waiting time for surgery by more than 10 h (intervention: 25.4 ± 24.5 vs. control: 35.8 ± 34.1 h; p = 0.013). A structured phone interview was not performed in 30.9% of the cases. The model reduced the overall dissatisfaction rate by more than half (12.9% vs. 32.4%; p = 0.008). On the other hand, the groups had similar perioperative complication rates (25% vs. 24.3%; p > 0.9999) and mortality (4.8% vs. 3.9%; p > 0.9999) and they remained similar at the 3-month follow-up (complications: 20.3% vs. 17.6% p = 0.831, mortality: 18.2% vs. 15.0% p = 0.573). Conclusion We found that two additions to the usual proximal femoral fracture regimen could significantly improve the overall satisfaction rate, reduce the length of hospital stay and shorten the waiting time for surgery. In contrast to previous studies, we observed no significant improvements in complication or mortality rates. Further changes in the standard care might be needed for this purpose.

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“…These studies have demonstrated decreased length of in‐hospital stays, and thereby decreased costs, in addition to improvements in the functional results with collaborative models. However, those improvements have not been demonstrated in other comparative works. In any case, there seems to be a certain consensus, also in Spain, that collaborative care offers specific advantages to clinical care compared to other models.…”

Section: Introductionmentioning

confidence: 93%

Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models

Pablos‐Hernández

González‐Ramírez

Casa

et al. 2020

Orthopaedic Surgery

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Objective: To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients. Methods:We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post-surgical stay, and in-hospital mortality according to the healthcare model applied.Results: Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A-B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009). The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in-hospital follow-up, there was a reduction in in-hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance.Conclusions: The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically-treated patients.

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Comparison of 3 Different Perioperative Care Models for Patients With Hip Fractures Within 1 Health Service

Cited by 10 publications

References 15 publications

Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult

Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult

Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference?

Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models

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