Coordinated care on Orthopedics Unit yields better results for hip fractures

From the left, Michael Leslie, DO, assistant professor, Orthopaedics and Rehabilitation, Yale School of Medicine; Brooke Spadaccino, RN, assistant patient service manager, 7-7; Maria Onofrio, PA; and Dr. Morris are some of the key team members who coordinate the care of patients who are admitted with hip fractures to the Orthopedics Unit.
From the left, Michael Leslie, DO, assistant professor, Orthopaedics and Rehabilitation, Yale School of Medicine; Brooke Spadaccino, RN, assistant patient service manager, 7-7; Maria Onofrio, PA; and Dr. Morris are some of the key team members who coordinate the care of patients who are admitted with hip fractures to the Orthopedics Unit.

Connecticut has one of the oldest populations in the U.S. and each year, more than 250 of its residents seek care at Yale-New Haven Hospital for a fractured hip.

Fractured hips for the elderly can be a life-altering event if not treated promptly and properly. For nearly three years, YNHH has been working to improve how it treats patients who have broken their hips and, according to Leo Cooney, MD, professor, Geriatrics, Yale School of Medicine, it appears that efforts are paying off.

"Many older patients who are admitted with hip fractures have other medical issues," explains Dr. Cooney. "In the past, we stabilized them on a medicine unit to prepare them for surgery. However, we began to notice that some hospitals had better outcomes when medicine and orthopedic surgery provided coordinated care on an orthopedic unit."

In 2011, members of emergency department faculty, anesthesiology, community and university orthopedics, hospitalists, geriatrics, physical therapy and orthopedic nursing reviewed best practices and began to develop protocols for better managing hip fractures. Members of physical therapy and care coordination are also involved in contributing to efforts to improve care for patients with hip fractures.

The new treatment plan now includes: completing appropriate laboratory tests and X-rays and placing an IV while the patient is still in the Emergency Department; admitting the patient directly to the orthopedic service where the patient will have both hospitalist and orthopedic coverage; and consultation with the resident anesthesiologist as soon as possible.

"Teamwork and expertise are making our new approach to hip fractures work," said Jensa Morris, MD, Hospitalist Service. "Our patients can be very the Orthopedic Unit, hospitalists follow these patients every day and are able to provide meticulous medical care while the patient receives the best in orthopedic and nursing care. Working together, we are far better at setting goals for them and all of this contributes to improved outcomes for patients."

In fact, after one year of the program, length of stay for hip fractures on the Orthopedic Unit (7-7) went from 7.25 days to 5.28 days; readmissions within 30 days decreased; complications of pneumonia and other infections decreased; and the number of deaths during hospitalization went down significantly.

"Clearly, the protocols we've developed show that we are able to enhance outcomes," Dr. Cooney points out. "The Saint Raphael Campus is very interested in learning more about our coordinated care and we have met with their team to plan a similar effort on that campus. We are also looking into extending this protocol to include rehabilitative care so patients continue to improve post-hospitalization. This is a great example of people coming together to work on the common goal of providing better care for the patient."