Mary E Anderson1, Kelly Mcdevitt2, Ethan Cumbler3, Heather Bennett4, Zachary Robison5, Bryan Gomez6, Jason W Stoneback7. 1. Assistant Professor in the Hospital Medicine Section of the Division of General Internal Medicine at the University of Colorado Denver School of Medicine. mary.anderson@ucdenver.edu. 2. Clinical Nurse Manager in the Department of Orthopedic Surgery at the University of Colorado Hospital in Aurora. kelly.mcdevitt@uchealth.org. 3. Professor in the Hospital Medicine Section of the Division of General Internal Medicine at the University of Colorado Denver School of Medicine. ethan.cumbler@ucdenver.edu. 4. Data Analyst for the Institute of Healthcare Quality, Safety, and Efficiency at the University of Colorado Hospital in Aurora. heather.bennett@uchealth.org. 5. Process Improvement Consultant for the Institute of Healthcare Quality, Safety, and Efficiency at the University of Colorado Hospital in Aurora. zach.robison@gmail.com. 6. Process Improvement Consultant for the Institute of Healthcare Quality, Safety, and Efficiency at the University of Colorado Hospital in Aurora. bryan.w.gomez@gmail.com. 7. Assistant Professor in the Department of Orthopedic Surgery at the University of Colorado Denver School of Medicine. jason.stoneback@ucdenver.edu.
Abstract
CONTEXT: Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. OBJECTIVE: To describe a stepwise approach to systems redesign for this patient population. DESIGN: We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. MAIN OUTCOME MEASURES: Hospital length of stay. RESULTS: We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. CONCLUSION: Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.
CONTEXT: Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. OBJECTIVE: To describe a stepwise approach to systems redesign for this patient population. DESIGN: We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. MAIN OUTCOME MEASURES: Hospital length of stay. RESULTS: We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. CONCLUSION: Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.
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