When frail, elderly patients with fractures are left untreated for long periods of time and care is coordinated poorly, their conditions can quickly snowball, resulting in a number of serious and costly outcomes that could have been avoided.
With that in mind, Baptist Memorial Hospital in Memphis recently instituted a “fragility fractures” program in its emergency department, aiming first to improve care for elderly patients and, at the same time, raise patient satisfaction and reduce costs.
As a result of the program, elderly patients with broken bones are posting better results. So, when a qualifying patient shows up at the ED with a fracture, the diagnosing doctor quickly activates the required treatment team — from surgeon to anesthesiologist, physical therapist and discharge planner. Surgeons are required to follow evidence-based protocols, and midlevel clinicians provide a “fracture liaison service” afterward to smooth out transitions and make sure patients receive the necessary follow-up care.
Since November, the program has shown promise, with length of stay for patients targeted by the program dropping 30 percent, or two days, to 4.7. The readmission rate, meanwhile, zeroed out from a previous average of 8.4 percent.
Dana Dye, R.N., president and CEO of the hospital and a former ED trauma nurse, says digging into the data was critical to finding places where patients were getting stuck along the process.
Hospitals need to start thinking of themselves as 24-hour operations that efficiently filter patients to surgery around the clock and, hopefully, within the same day. Such careful coordination and planning will prove to be essential in a world of bundled payments for each episode of care, she adds.
“Every hospital, for years, has struggled with how you deliver great care of patients within a shorter window of time,” she says. “It behooves hospitals to take each program and break it down into time increments of how things happen, to be able to really home in on the root cause of the problem.”
The goal, Dye says, is to eventually drop the time for geriatric patients with fractures to get into surgery to between 12 and 24 hours. They’ve reduced the time to get such patients into the operating room to a little more than 30 hours from almost 43 hours.
Typically, fragility fracture programs are ideal for hospitals that treat 100 or more geriatric patients with hip fractures each year, according to hospital outsourcing company TeamHealth, which works with Baptist Memorial. Todd Lang, M.D., a TeamHealth physician who works as medical director of emergency services at Baptist, says executive support is essential. “Managers and directors work on what they believe is important to their supervisors,” Lang says. “This has to be a CEO-supported project.”