Establishing a Fracture Liaison Service: An Orthopaedic Approach

Miller, Anna N.; Lake, Anne; Emory, Cynthia L.

doi:10.2106/jbjs.n.00957

Cited by 70 publications

(40 citation statements)

References 78 publications

(80 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Admitting patients to a primary orthopedic service has also streamlined postoperative referrals to our outpatient fracture liaison service for management of bone health and prevention of fragility fractures. 29 Although the downstream financial savings associated with early initiation of osteoporosis treatment is unclear, it is reasonable to assume that we can help prevent additional fragility fractures with early intervention. 28 …”

Section: Discussionmentioning

confidence: 99%

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

Bracey

Kiymaz

Holst

et al. 2016

Geriatr Orthop Surg Rehabil

Self Cite

View full text Add to dashboard Cite

Introduction:Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden. Comanagement strategies are reported in the literature, but few have addressed orthopedic-hospitalist models. An orthopedic-hospitalist comanagement (OHC) service was established at our hospital to manage hip fracture patients. We sought to determine whether the OHC (1) improves the efficiency of hip fracture management as measured by inpatient length of stay (LOS) and time to surgery (TTS) and (2) whether our results are comparable to those reported in hip fracture comanagement literature.Methods:A comparative retrospective–prospective cohort study of patients older than 60 years with an admitting diagnosis of hip fracture was conducted to compare inpatient LOS and TTS for hip fracture patients admitted 10 months before (n = 45) and 10 months after implementation (n = 54) of the OHC at a single academic hospital. Secondary outcome measures included percentage of patients taken to surgery within 24 or 48 hours, 30-day readmission rates, and mortality. Outcomes were compared to comanagement study results published in MEDLINE-indexed journals.Results:Patient cohort demographics and comorbidities were similar. Inpatient LOS was reduced by 1.6 days after implementation of the OHC (P = .01) without an increase in 30-day readmission rates or mortality. Time to surgery was insignificantly reduced from 27.4 to 21.9 hours (P = .27) and surgery within 48 hours increased from 86% to 96% (P = .15).Discussion:The OHC has improved efficiency of hip fracture management as judged by significant reductions in LOS with a trend toward reduced TTS at our institution.Conclusion:Orthopedic-hospitalist comanagement may represent an effective strategy to improve hip fracture management in the setting of a rapidly expanding patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

Bracey

Kiymaz

Holst

et al. 2016

Geriatr Orthop Surg Rehabil

Self Cite

View full text Add to dashboard Cite

show abstract

“…An important strength of using our model of implementation consisted in the use of personnel already in place in the hospital. Most of FLSs use dedicated personnel to run their program [33, 34]. Our results show that it is possible to sustain such a service with staff nurses already on the payroll.…”

Section: Discussionmentioning

confidence: 91%

The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service

Senay

Delisle

Giroux³

et al. 2016

Osteoporos Int

View full text Add to dashboard Cite

SummaryWe analysed the impact of a standardized order set empowering staff nurses to independently manage a Fracture Liaison Service over a 9-month period. Nurses identified between 30 and 70 % of non-hip fragility fractures to the unit in charge of management over time. The latter managed 58 % of referred patients.IntroductionThe main goal of this study was to evaluate the impact of a standardized order set empowering nurses to independently manage a fracture liaison service (FLS).MethodsSince November 2014, an order set allowed nurses of a Montreal hospital, Quebec, Canada to entirely manage an FLS on their own. Nurses followed an 6-h training program on-site. Emergency department (ED) and orthopaedic outpatient clinic (OC) nurses identified non-hip fragility fractures. Medical day treatment unit (MDTU) nurses were in charge of the management (investigation and treatment initiation). The list of patients, 50 years and older, with a fracture were retrieved for the period of November 2014 to July 2015. Performance was assessed with the rate of identification over time and the rate of management of non-hip fragility fractures.ResultsOver the 9-month period, 346 patients of ≥50 years old were seen for a fracture, of which 190 met fragility criteria (excluding hip fractures). A sinusoid pattern of rates of identification between 30-70 % was observed over time. An average proportion of 58.1 % of fracture patients were managed by MDTU nurses.ConclusionsA standardized order set legally allowing nurses to manage an FLS led to identification rates varying from 30–70 % and a management rate close to 60 % for referred patients over a 9-month period, which largely exceeds that of standard care. Identification was mostly compromised by difficulty integrating the order set into routine practice. Enforcement of the hospital policy on fragility fractures could help yield efficiency of identification of osteoporosis-related fractures by the staff.

show abstract

“…The annual incidence of osteoporosis has been estimated at 9 million fractures worldwide, which is likely to increase as a consequence of aging [2,3]. In the United States, 10.2 million people are affected by osteoporosis and 43.4 million by low bone mass, equaling a quarter of the whole adult population [4]. The impact is similar in Canada, Europe, and Asia [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…On average, patients suffering from osteoporotic fractures increase their risk of exposure to a second fracture by 86%. When the first fracture affects the vertebrae or the hip, the percentage reaches 200%, and 300%, respectively [4]. Despite the well-known benefits of preventive bone health assessment [15] and osteoporotic drugs, most people presenting with a fragility fracture are neither assessed for osteoporosis, nor appropriately managed to prevent further fractures, irrespective of different countries and health care systems [16].…”

Section: Introductionmentioning

confidence: 99%

Fragility Fracture Prevention—Implementing a Fracture Liaison Service in a High Volume Orthopedic Hospital

Pennestrì

Corbetta

Favero

et al. 2019

IJERPH

View full text Add to dashboard Cite

Fragility fractures pose a serious threat to patient health, quality of life, and healthcare sustainability. In order to reduce their clinical, social, and economic burden, a Fracture Liaison Service (FLS) was introduced in a high volume orthopedic hospital in 2017. The purpose of this retrospective observational study is to describe the FLS protocol, introduce its preliminary outcomes, and provide an early evaluation in light of international guidelines and recommendations. All the performances suggested by the International Osteoporosis Foundation (IOF) are provided under the same institution by which a patient is admitted for surgery. Clinical indicators from patient history and administrative indicators from the hospital database have been used to estimate the spread of fragility fracture prevention and the degree of patient compliance to these programs. The research included 403 patients. Although, almost 1/3 were admitted for the second fragility fracture, only half received anti-osteoporotic treatment before it. The degree of prevention was even lower in the case of patients admitted for the first fragility fracture. The risk of being affected by a secondary fracture was seven times higher when patients did not attend any follow-up or diagnostic exam. In order to identify the main determinants of compliance with FLS and perform a cost-effectiveness analysis on a larger sample, it is fundamental to integrate data from different providers.

show abstract

Establishing a Fracture Liaison Service: An Orthopaedic Approach

Cited by 70 publications

References 78 publications

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service

Fragility Fracture Prevention—Implementing a Fracture Liaison Service in a High Volume Orthopedic Hospital

Contact Info

Product

Resources

About