Geriatric Hip Fracture Care: Fixing a Fragmented System

Abstract

The International Osteoporosis Foundation (IOF) has developed this toolkit to facilitate the implementation of Fracture Liaison Services (FLS). Used in conjunction with resources from the IOF Capture the Fracture ® initiative (www.capturethefracture.org), the toolkit gives those wanting to establish an FLS the case for, and the resources to, enable FLS expansion. WHAT'S IN THIS TOOLKITThe following tools are to support clinicians, health administrators and policymakers in the implementation of effective FLS based on successful experiences from established high performing FLS. Understanding the need for FLSA guide to understanding the size of the problem and why FLS is the solution to secondary fracture prevention. FLS implementation guideA step-by-step 'how to' guide to design and implement an FLS in hospitals and health systems throughout the world. FLS business planning process guideA tool intended to support clinicians and health administrators in the FLS business planning process, including a generic FLS business plan template. Multi-sector FLS coalition guideA tool intended for national osteoporosis societies and national healthcare professional organizations to establish an effective national coalition to drive widespread adoption of FLS in your country.

Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists

“…Previous studies have assessed the impact of having hospitalists or geriatricians participate in the care of patients with hip fracture during their hospital stay. Some of these studies reported a decrease in the 7-day readmission rate, 13 LOS, 12 , 14 – 16 preoperative echocardiograms, 8 , 14 time to surgery, 8 , 10 , 12 , 14 inpatient mortality, 8 , 9 1-year mortality, 11 , 12 pressure ulcers, 10 prescription of potentially inappropriate medications, 27 and cost of care. 14 Several of the studies reported an improvement in 4-month mobility among home-dwellers, 7 better pain control, 8 and an increase in assessments for osteoporosis.…”

“… 14 Several of the studies reported an improvement in 4-month mobility among home-dwellers, 7 better pain control, 8 and an increase in assessments for osteoporosis. 10 , 14 , 16 On the other hand, some studies reported no difference in the 30-day readmission rate, 8 , 14 , 15 LOS, 8 , 28 time to surgery, 15 30-day mortality, 14 falls, 10 or prescription of osteoporosis medications. 8 One study that used data from the National Surgical Quality Improvement Program showed that comanagement models were associated with an increase in 30-day mortality and morbidity.…”

“…Consequently, comanagement models of care have been popularized in which geriatricians 7 8 9 10 11 12 or hospitalists 13 14 15 16 17 18 participate in the care of patients with hip fracture during their hospital stay. However, in many of these models, the hospitalist rotating on the General Medicine consult service on that day would be consulted “as needed” by the orthopaedic surgery service (often after medical complications had already occurred).…”

Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care

“…High- risk, high-need patients will be identified earlier and optimized. Osteoporosis care to reduce the risk of secondary fractures can be poorly co-ordinated [41], but the efficiency of this care is improved by an orthogeriatric fracture unit [42,43]. Interestingly, hip fracture care in the UK does not suffer from the apparent “weekend effect” where higher observed mortality rates are attributed to lower staffing levels in place at weekends.…”

Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society

“…In the case of hip fracture patients, many other aspects of care are important, calling for some standardization of PAC for this population ( Table 1 ). 19 - 22 There is a subgroup of patients who suffer a hip fracture and do not undergo surgical repair. Part of this group represents those for whom surgery is not indicated due to the type of fracture, and the other part includes patients who due to their functional status at the time of the injury or severity of illness cannot undergo or might not benefit from surgical management.…”