1013 / Multidisciplinary approach to hip fracture

SPAIN
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Other
There is no specified text here There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
Hip fracture is one of the most common serious diseases in the elderly and the most frequent cause of hospital admission in the Orthopaedics units. In Spain, the incidence is 100 cases/100.000 inhabitants / year. The average age is around 80 years and is more common in women (3:1). This group of patients also often have other (acute and / or chronic) medical conditions that could explain the high rate of morbidity and mortality associated with perioperative period.
According to a report by the World Health Organization (WHO) and the International Osteoporosis Foundation (IOF) "it is expected that the number of hip fractures due to osteoporosis triple in the next 50 years." This is a growing and significant health burden, for the family and at social and economic level.
It is therefore a major and complex health issue and where different medical specialties are involved
Based on published clinical evidence, our goal is to unify and improve treatment outcomes in these patients from admission to the emergency department to hospital discharge.
Description of the Patient Safety Practice
 
A literature review of articles published between January 2007, date of last update of the guidelines for hip fracture in the Hospital Universitario de la Ribera, and March 2013 was conducted . Controlled trials were included, meta-analysis and published guidelines in hospital care to fracture hip in the absence of multiple trauma and metastatic neoplastic disease. The studies were reviewed by the interdisciplinary team responsible for drafting the guideline, which was formed by four anesthetists, an emergency physician, a traumatologist, a hematologist, two geriatricians, a rehabilitation specialist, nursing staff and responsible management department of healthcare quality.
Planning and evaluation process has been fundamental to understanding and strengthen those weaknesses in the approach to these patients
After nearly a year and a half of work consensus has been achieved to draft the guidance of hip fracture.
Emergency area indicators are monitored as: the time between arrival and Emergency medical care in less than an hour, the time between arrival and plain radiography of the hip in less than an hour, the percentage of patients with lower visual pain scale 3 before performing hip radiograph.
As for the average hospital stay for patients undergoing hip fracture is measured, the percentage of patients seen by the internist or geriatrician guard in less than 8 hours, patients with appropriate antibiotic prophylaxis in patients undergoing less of 36horas from admission and mortality and readmissions among others. Following the diagnosis of hip fracture upon hospital admission, each patient was assigned to a traumatologist, a geriatrician and a nurse team for the duration of his/her hospital stay. The geriatrician and traumatologist evaluated the patient during the first 24 hours and daily thereafter. After the surgical procedure, the rehabilitation department examined the patient and initiated rehabilitation therapy within the first 48 hours after surgery.
For the first evaluation, the traumatologist evaluated the patient and decided on the suitability of the surgical treatment and the technique to be used, and the geriatrician used a comprehensive geriatric assessment (CGA) that included an assessment of functional, cognitive and social issues. Furthermore, co-morbidities and the clinical condition of each patient were evaluated at the time of admission to establish a pre-operative treatment plan. For patients with a diagnosis of previous cognitive impairment or those with delirium at the time of the survey, data were obtained from the main care giver. When considered necessary by the geriatrician, the social worker examined the social network of the patient and advised on measures that could strengthen it upon discharge.
The decision for patient discharge was agreed upon by the traumatologist, geriatrician and rehabilitation specialist. When considered necessary, rehabilitation was continued after hospital discharge at reference rehabilitation sites.
This designed model attempted to provide early, integral care with an emphasis on early geriatric assessment, surgical procedure selection and the initiation of rehabilitation therapy to recover patient mobility in the shortest possible time following surgery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370304/pdf/cln-67-06-547.pdf

Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
cln-67-06-547.pdf
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There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Therapists
Social workers
Technical support / technician
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Collaboration, such as co-designing a Patient Safety Practice or active partnership in implementation
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
Diptychs ,and we use calendars or other tools to prevent delirium in elderly
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Sharing of progress information among involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: FRANCISCO TARAZONA
Country: SPAIN
Organisation: HOSPITAL UNIVERSITARIO DE LA RIBERA
E-mail: calidad@hospital-ribera.com
Phone: There is no specified text here
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