Gupta A
A Gupta Glangwili Hospital Carmarthen SA31 2AF, UK tel. +44 (0)126 722 7740 e-mail
J R Coll Physicians Edinb. 2014;44(1):20-6. doi: 10.4997/JRCPE.2014.105.
We introduced a new model of care for patients with hip fractures involving a multidisciplinary approach. We then assessed the impact of this geriatrician-led comprehensive and collaborative hip fracture care on hip fracture outcomes.
The traditional model of care comprised of patients being managed on an orthopaedic ward under the care of one of ten orthopaedic surgeons, with a weekly orthogeriatric liaison. In this study model, hip fracture patients were directly admitted from the emergency department to a new, acute, dedicated hip unit that provided joint patient care by orthopaedic surgeons and an orthogeriatrics team. Intervention measures included fast track admission, a preoperative geriatric assessment, daily geriatrician-led clinical care on weekdays and general medical support on weekends. Standard protocols were implemented. Weekly geriatrician-led multidisciplinary meetings were held with an emphasis on early mobilisation and early discharge planning.
There was a significant reduction in the time to surgery performed within 48 hours (86% vs 77% p=0.013) and in the hospital length of stay (34 vs 19.6 days p<0.001).
The main reasons for the improved outcomes in the study could include the multidisciplinary teamworking with geriatrician-led pre and post-operative care, and working closely with orthopaedic surgeons. Additionally, implementation of systematic protocols could have contributed to positive results.
我们引入了一种针对髋部骨折患者的新型护理模式，该模式采用多学科方法。然后，我们评估了这种由老年医学专家主导的全面协作式髋部骨折护理对髋部骨折治疗结果的影响。
传统护理模式包括患者在骨科病房由十位骨科医生之一进行管理，并每周进行一次骨科与老年医学联络。在本研究模式中，髋部骨折患者从急诊科直接入住一个新的急性专用髋部病房，该病房由骨科医生和老年医学团队提供联合患者护理。干预措施包括快速入院、术前老年医学评估、工作日由老年医学专家主导的日常临床护理以及周末的一般医疗支持。实施了标准方案。每周举行由老年医学专家主导的多学科会议，重点是早期活动和早期出院计划。
48小时内进行手术的时间显著缩短（86%对77%，p = 0.013），住院时间也显著缩短（34天对19.6天，p < 0.001）。
本研究中治疗结果改善的主要原因可能包括多学科团队合作，由老年医学专家主导术前和术后护理，并与骨科医生密切合作。此外，系统方案的实施可能也促成了积极的结果。
