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Coordinated care on Orthopedics Unit yields better results for hip fractures

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."

Yale-New Haven Hospital news release

Yale-New Haven Hospital is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine. Yale-New Haven was founded as the fourth voluntary hospital in the U.S. in 1826. Today, the hospital's two New Haven-based inpatient campuses include Yale-New Haven Children's Hospital, Yale-New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. YNHH's York Street campus and associated ambulatory sites are Magnet-designated by the American Nurses Credentialing Center.

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