Date post: | 02-Jun-2015 |
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Health & Medicine |
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HIP FRACTURE MANAGEMENT PATHWAY:
NEPEAN HOSPITAL CASE STUDY
Prof. Gustavo Duque, MD, PhD, FRACP
Director – Geriatric Medicine Section & Ageing Bone Research Program
Sydney Medical School Nepean
Nepean Hospital, Penrith, NSW
Disclosures
-Consultant for Sanofi, P&G, Novartis.
-Research grants from Merck, Novartis, Amgen, Sanofi, P&G,
Servier, Key Pharmaceuticals
http://www.bbc.co.uk/news/10353642
A case of neck of femur (NOF) fracture at Nepean
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Emergency Department
Orthopaedic Surgeon
-Surgical criteria
-Booking of theatre
Geriatrician
-Multi-disciplinary
assessment
-Clinical stability
A case of NOF fracture at Nepean
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Orthopaedic Ward
Orthopaedic Surgeon
- Follow up
- Preparation for Sx
(within 24 hours)
Geriatrician
- Pre-op assessment
- Other consultants
- Electronic pathway
Liaison Nurse
(Orthopedics)
- Assessment
- Care plan
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A case of NOF at Nepean
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Surgery
A case of NOF fracture at Nepean
Orthopaedic Ward
Orthopaedic Surgeon
- Follow up
- Preparation for
discharge
Geriatrician
- Post-op assessment
- Electronic pathway
- Discharge planning
Liaison Nurse
(Orthopedics)
- Discharge planning
Fracture Care Coordinator
(Geriatrics)
- Comprehensive risk
assessment (falls and
fractures)
- Appointment at F&F Clinic
- Follow up (8 weeks post
discharge) - Research
A case of NOF fracture at Nepean
- Constipation
- Wound care
- Blood transfusion
- Urinary catheterization
- Pressure care area
- Nutrition
- Delirium
- Serum vitamin D/PTH/Ca/P
- Antithrombotic prophylaxis
- Pain relief
- Oxygen therapy
- Fluid and electrolyte balance
- Weight bearing
- Early mobilization
- Physiotherapy
- Hip precautions
After the Surgery
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A case of NOF fracture at Nepean
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Orthopaedic Ward - Discharge
Orthogeriatrics
Rehab Residential Aged Care Rehab Hospital
Falls and Fractures Clinic
Components of our Falls and Fractures Clinic
›Physical examination
›Cognitive assessment
›Nutritional Assessment
›Medications review
›Gait assessment
›Balance Assessment
›Environment assessment
›Evidence-based interventions
Components of our Falls and Fractures risk assessment
›Nutritional assessment
-Mini-nutritional assessment
tool
Components of our Falls and Fractures risk assessment
›Medications review - Indication
-Dosing
-Side effects
- Interactions
Balance assessment
Bone mineral density
Quantification of sarcopenia
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Gait Assessment
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The Orthogeriatrics Model: Testing the effectiveness of an integrated model of care in older patients with neck of femur fracture. M. Martinez-Reig1,2 , N. Vignakaran3, P. Kurusumuthu3, J. Smith3, O. Demontiero1,3, G. Loza-Diaz1,
L. Sardinha3, A. Sharma3, G. Duque1,3
1. Ageing Bone Research Program, Sydney Medical School Nepean – The University of Sydney, Penrith, NSW, Australia.
2. Geriatric Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
3. Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia.
The investigators retained full independence in the conduct of this research.
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METHODS
Two geriatricians run the model with the assistance of a multidisciplinary team. Assessments included surgical risk, physical examination, nutrition, cognition, and blood tests (blood count, biochemistry, electrolytes, and calciotropic hormones).
A comprehensive intervention plan was designed following established guidelines: Agency for Clinical Innovation of NSW
(www.aci.health.nsw.gov.au/).
Two populations of NOF fracture patients admitted before (2006) and after (Jan 2011-June 2012) the implementation of the program were compared.
Uni and multivariate regression analysis models were used to determine association between the groups and the different co-variables.
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Predictors of early adverse events after
NOF fracture
Martinez-Reig et al, Submitted data
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Predictors of early adverse events after
NOF fracture
Martinez-Reig et al, Submitted data
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Martinez-Reig et al, Submitted data
2006 group has increased risk for: 2011-12 group has better results on:
Summary
›Evidence-based interventions work!
›Prevent post-op complications and increase
survival
›Care pathways are highly recommended
›Early rehab and mobilization are essential
›Think about late mortality
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›Close partnership with the orthopaedic
surgeons is pivotal
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Ageing Bone Research Program Nepean – Clinical Section &
Departments of Geriatrics and Orthopaedics – Nepean Hospital
• Luis Sardinha
• Anita Sharma
• Oddom Demontiero
• Piumali Gunawardene
• Pushpa Suriyaarachchi
• Registrars and advanced trainees
• Rami Sorial
• Orthopaedic Surgeons
• Jenny Smith
• Griselda Loza-Diaz
• Bona Treder
• Derek Boersma
• Sanobar Hassan
• Deanna Davies
Acknowledgements
www.boneresearch.edu.au
www.fallsandfractures.com