Integrated Fragility Hip Fracture Program: A Model for High Quality Care
BACKGROUND: Hip fractures are a significant cause of morbidity and mortality among elderly patients. Coordinated multidisciplinary care is required to optimize medical outcomes.
OBJECTIVE: To determine the effect of the implementation of standardized, evidence-based protocols on clinical outcomes and mortality in patients with fragility hip fractures.
INTERVENTIONS: A multidisciplinary group was convened to define best practices in fragility hip fracture care and implement a fragility hip fracture clinical protocol at Yale-New Haven Hospital. Clinical outcomes in 2015, prior to program initiation, were compared with 2018, after the program was well established.
MAIN OUTCOMES AND MEASURES: Measured outcomes included 30-day mortality, blood transfusion utilization, adverse effects of drugs, venous thromboembolic complications, sepsis, myocardial infarction, mechanical surgical fixation complications during the index admission, length of stay, 30-day readmission, unexpected return to the operating room (OR) and time to the OR.
RESULTS: The implementation of the Integrated Fragility Hip Fracture Program was associated with significant reductions in 30-day mortality from 8.0% in 2015 to 2.8% in 2018 (P = .001). Significant reductions were also seen in use of blood transfusions (46.6% to 28.1%; P < .001), adverse effects of drugs (4.0% to 0%; P < .001), length of stay (5.12 to 4.47 days; P = .004), unexpected return to the OR (5.1% to 0%; P < .001), and time to the OR <24 hours (41.8% to 55.0%, P = .001). CONCLUSIONS: An Integrated Fragility Hip Fracture Program using multidisciplinary care, physician and nursing engagement, evidence-based protocols, data tracking with feedback, and accountability can reduce mortality and improve clinical outcomes in patients with hip fractures.
© 2020 Society of Hospital Medicine
CONCLUSIONS
The CMC at Yale School of Medicine and Yale-New Haven Hospital IFHFP provides a model for implementing well-documented evidence-based interventions to standardize the care of patients with fragility hip fractures. The IFHFP yielded reduced mortality, length of stay, blood transfusion utilization, adverse effects of medications, unexpected return to the OR, and time to the OR.
Acknowledgments
The authors thank the work of the Center for Musculoskeletal Care Hip Fracture Oversight Group, program surgeons, and community primary care leaders: Olukemi Akande, MD, Mark Altman, MD, Diren Arsoy, MD, John Aversa, MD, Michael Connair, MD, Leo Cooney, MD, Kenneth Donohue, MD, David Gibson, MD, Gail Haesche, RN, MS, ACM-RN, Carol Just, MSN, NEA-BC, RN, Patricia Kenyon, RN, ACM, Francis Lee MD, Michael Leslie, MD, Michael Lucchini, MD, Christopher Lynch, MD, Rowland Mayor, MD, Tara Messina, PT, Lorraine Novella, RN, Paul Oliver, PA-C, Vivek Parwani, MD, Joseph Quaranta, MD, Lee Rubin, MD, Derek Shia, MD, Jeff Sumner, MD, John Tarutis, Arya Varthi, MD, Anuruddha Walaliyadda, MD, Daniel Wiznia, MD, Shirvinda Wijesekera, MD, Joseph Wu, MD, Brad Yoo, MD, and James Yue, MD.
