Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures

Roll, C.; Tittel, Sandra; Schäfer, Malte; Burkhardt, Janosch; Kinner, Bernd

doi:10.1007/s00402-018-3086-7

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…The development, implementation and evaluation of a DTAP is a continuous process well represented in the Plan-Do-Check-Act cycle, where the stages of creation of a DTAP are inserted in the Plan phase of the cycle, the D phase foresees its application, the C phase foresees its evaluation, and finally, the A phase a standardization or improvement. The planning phase of the route becomes strategic and is structured as follows (Ueda et al , 2015; Roll et al , 2019): selection of the health problem; constitution of the working group: multi-professional and multidisciplinary; choice of inclusion (I) and exclusion (E) criteria from the DTAP; critical analysis of scientific literature; review of current practice; sustainability assessment; drafting of the DTAP and its graphic representation; evaluation system planning: process and outcome indicators, clinical audit; and plan of dissemination, training and process of growth of patients and operators (empowerment). …”

Section: Introductionmentioning

confidence: 99%

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Improta¹,

Ricciardi

Borrelli³

et al. 2019

IJLSS

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Purpose The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity and socio-economic impact. In the hospital A.O.R.N. Cardarelli of Naples in Italy, the mean pre-operative length of hospital stay (LOS) was nine days and just 4 per cent of patients was operated within the suggested time. Therefore, a diagnostic-therapeutic-assistance path (DTAP) was implemented to improve the process. Design/methodology/approach This paper analyzes two groups of patients (534 and 562, respectively) before and after the introduction of DTAP, through six sigma (SS) based on define, measure, analyze, improve and control cycle. Age, gender, American Society of Anaesthesiologists (ASA) score, cardiovascular diseases, diabetes and allergies were used as independent subgrouping variables. The t-tests and chi-square were performed to compare the groups, tools of SS were used. Findings The analyses were conducted considering overall patients and some subgroups. The overall reduction in LOS was about 54 per cent, patients without cardiovascular diseases and with a low ASA score had the highest reduction, more than 60 per cent. All the p-values proved a high statistically significant difference between the two groups. Research limitations/implications The influence of the Italian health-care system is a minor limitation while, unfortunately, the lack of a follow-up did not allow quantifying the real gain in health of patients. A lean thinking analysis would suit this context. Practical implications There are practical advantages for both hospital and patients: the hospital will have an increase in admissions and more beds available, while patients will benefit of a faster intervention and a shorter wait. Originality/value This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome. Policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.

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Section: Introductionmentioning

confidence: 99%

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Improta¹,

Ricciardi

Borrelli³

et al. 2019

IJLSS

View full text Add to dashboard Cite

show abstract

“…A co-management system should be tailored to each site and country based on preexisting infrastructure and resources. Most of these studies suggest that co-management model can effectively reduce the rates of perioperative complications, short-term mortality and long-term mortality in older patients with hip fractures ( 17 – 20 ); whereas some studies suggest no, or uncertain, improvement in these outcomes ( 21 – 23 ). Despite several models have been published, there are still no clear recommendations on organization of multidisciplinary co-management team, and no guidelines on further changes in the standard of care that might be needed for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Whether Emergency Physicians Should Join the Multidisciplinary Team for Older Hip Fracture Patients

et al. 2022

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BackgroundGeriatric hip fracture is one of the most common end-stage events in older patients with osteoporosis. We aimed to improve the original co-management process by engaging emergency physicians in the preoperative multidisciplinary management team (MDT). We evaluated this intervention in terms of reducing patient waiting time before surgery.MethodsEmergency Department data and hospitalization data for patients diagnosed with geriatric hip fractures in Beijing Jishuitan Hospital (JSTH) were collected and sorted into the intervention group, for whom the MDT included emergency physicians (from January 2019 to December 2019), and the control group (from January 2017 to December 2017). The percentage of patients treated with surgery within 48 h of admission was used as the primary outcome. The secondary outcomes included the time from emergency visit to admission (hours), the time from admission to discharge (days), the percentage of patients receiving surgical treatment after admission, the rate of perioperative medical complications during hospitalization, postoperative admission to the Intensive Care Unit, and total deaths during hospitalization.ResultsA total of 2,152 patients were enrolled. The rate of hypertension (58.5% vs 52.1%), coronary heart disease (24.6% vs 19.9%), and cerebrovascular disease (19.4% vs 15.5%) was higher in the intervention group than in the control group. The percentage of patients receiving surgical treatment in the intervention group (98.3%) was significantly higher than in the control group (96.3%, p = 0.004). The proportion of patients receiving surgical treatment within 48 h of admission was significantly higher in the intervention group (82.4%) than in the control group (60.4%, p < 0.001). The hospital stay was significantly shorter in the intervention group compared with the control group (p < 0.001). The incidence of perioperative medical complications and mortality during hospitalization was similar in the two groups.ConclusionsInvolving emergency physicians in the MDT can reduce the waiting time before surgery and the hospital stay for older hip fracture patients.

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“…Orthogeriatrics is a subspecialty developed in response to clinical, social and financial needs in the management of patients with fragility fractures, and more specifically hip fractures (Sabharwal & Wilson, 2015). This medical unit commonly accommodates complex frail older patients with multifaceted comorbidities (Roll, Tittel, Schäfer, Burkhardt, & Kinner, 2019) and tends to require multidisciplinary team approach to clinical care. Geriatric patients taking more than five medications should be identified upon admission and flagged for pharmacist review.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy and medication related falls risk in orthogeriatric femoral fracture patients Polypharmacy and medication related falls risk in orthogeriatric femoral fracture patients

Tran

Koong

Knorr

2022

British Journal of Pharmacy

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Aim: To reportpolypharmacy rates and identify specific medications that increase falls riskin orthogeriatric femoral fracture patients. Method: A retrospectivesub-analysis, using the electronic medical records of patients admitted with a minimaltrauma femoral fracture to a tertiary teaching hospital during a 12-monthperiod was undertaken. Specific medications associated with falls risk wereclassified under three specific groups: benzodiazepines, tricyclicantidepressants (TCAs), and non-benzodiazepine hypnotics. Results: A sample of 131patients was included in the audit. Of these, 99 patients (75.6%) were reportedto be taking five or more medications prior to their falls related admission.From this, 49 patients (37.4%) were taking ten or more medications. One in fivepatients were found to be taking specified falls risk medications prior toadmission, primarily benzodiazepines (75.8%). Conclusion: Orthogeriatricpatients admitted to hospital with a femoral fracture following a minimaltrauma fall were commonly taking five or more medications prior to admission.Over a third of patients that were reported to take ten or more pre-admissionmedications were taking specified falls risk medications. This highlights theneed for medication-reviews and de-prescribing, particularly focusing on fallsrisk medications, to reduce incidence of falls and minimal trauma fractures inhigh risk patients

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Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures

Cited by 10 publications

References 34 publications

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

The application of six sigma to reduce the pre-operative length of hospital stay at the hospital Antonio Cardarelli

Evaluation of Whether Emergency Physicians Should Join the Multidisciplinary Team for Older Hip Fracture Patients

Polypharmacy and medication related falls risk in orthogeriatric femoral fracture patients Polypharmacy and medication related falls risk in orthogeriatric femoral fracture patients

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