Kristin O'Mara-Gardner, MSN, RN-BC, ONC, Geriatric Fracture Coordinator, ProMedica Toledo Hospital, Toledo, OH.
Roberta E. Redfern, PhD, Research Scientist, ProMedica Toledo Hospital, Toledo, OH.
Orthop Nurs. 2020 May/Jun;39(3):171-179. doi: 10.1097/NOR.0000000000000655.
Traditional care of patients with geriatric hip fracture has been fragmented with patients admitted under various specialty services and to different units within a hospital. This produces inconsistent care and leads to varying outcomes that can be associated with increased length of stay, delays in time from admission to surgery, and higher readmission rates.
The purpose of this article is to describe the process taken to establish a successful geriatric hip fracture program (GFP) and the initial results observed in a single institution after its implementation.
All patients 60 years or older, with an osteoporotic hip fracture sustained from a low energy mechanism (defined as a fall from 3-ft height or less), were included in our program. Fracture patterns include femoral neck, intertrochanteric, pertrochanteric, and subtrochanteric femur fractures including displaced, nondisplaced, and periprosthetic fractures. Preprogram data included all patients admitted from January 1, 2012, through December 31, 2014; postprogram data were collected on patients admitted between May 1, 2016, and May 1, 2018.
Demographic characteristics of the populations were similar. After the GFP was implemented, the proportion of patients who were treated surgically within 24 and 48 hours increased. The average number of hours between admission and surgery significantly reduced from 35.2 to 23.2 hours. Overall length of stay was decreased by 1.8 days and readmission within 30 days of discharge was lower. Reasons for readmission were similar in both timeframes. The rate of inpatient death was similar in the two groups. Mortality within 30 days of surgery appeared somewhat higher in the post-GFP period.
Our program found that, with the utilization of a multidisciplinary approach, we could positively influence the care of patients with geriatric hip fracture through the implementation of evidence-based practice guidelines. In the first 2 years after initiation of the GFP, our institution saw a decrease in time from admission to surgery, length of stay, and blood transfusion requirements.
传统的老年髋部骨折患者护理是碎片化的，患者根据不同的专科服务和医院内的不同科室进行收治。这导致护理不一致，导致结果各异，可能与住院时间延长、从入院到手术的时间延迟以及再入院率升高有关。
本文旨在描述建立成功的老年髋部骨折项目（GFP）的过程，并介绍该项目在一家机构实施后的初步结果。
所有 60 岁及以上、由低能量机制（定义为从 3 英尺或以下的高度跌倒）导致的骨质疏松性髋部骨折患者均纳入本项目。骨折类型包括股骨颈、转子间、转子下和股骨小转子骨折，包括移位、无移位和假体周围骨折。项目前数据包括 2012 年 1 月 1 日至 2014 年 12 月 31 日期间收治的所有患者；项目后数据采集于 2016 年 5 月 1 日至 2018 年 5 月 1 日期间收治的患者。
患者人群的人口统计学特征相似。在 GFP 实施后，24 小时和 48 小时内接受手术治疗的患者比例增加。从入院到手术的平均时间显著缩短，从 35.2 小时减少到 23.2 小时。总住院时间减少了 1.8 天，出院后 30 天内再入院率降低。两个时间段的再入院原因相似。两组患者的住院内死亡率相似。术后 30 天内的死亡率在 GFP 实施后似乎略高。
本项目发现，通过采用多学科方法，我们可以通过实施基于证据的实践指南，积极影响老年髋部骨折患者的护理。在 GFP 启动后的头 2 年，我们机构看到从入院到手术的时间、住院时间和输血需求都有所减少。
