Fracture fragility is a huge concern for hospitals and surgeons, as one-year mortality rates are estimated around 30 percent, according to a TeamHealth white paper titled "The Fragility Fracture Program: Improving Quality of Care for a Challenging Population." The at-risk population includes patients 65 years or older and those with osteoporosis. There are around 10 million people in the United States with osteoporosis according to the National Osteoporosis Foundation and another 34 million who are at risk because of low bone mass. High fracture rates cost hospitals in clinical quality, outcomes, patient satisfaction and financial performance. However, a dedicated fragility fracture program can avoid some of these instances in the future.
Fragility fracture patients need care from orthopedic surgeons, anesthesiologists, internal medicine physicians and many others to achieve stabilized discharge. The pharmacy department is also often handling multiple medications for those patients and there isn't always coordinated care. But, a fragility fracture program allows hospitals to "create an integrated process of care in which every provider in the chain of care knows his or her individual role and expectations," according to TeamHealth. The program includes evidence-based medicine protocols and pathways to manage high-risk patients and deliver better, more efficient and coordinated care. Hospitals with a fragility fracture program can reach the Triple Aim goals of improving care for the geriatric population and providing a better experience while also reducing costs.
When high-risk patients come to the hospital with specific fractures, diagnosing physicians identify their issue and begin the specific protocol for the each patient's condition. For example, elderly patients who arrive in the emergency department with a hip fracture will be assigned a specific pathway for care. The diagnosing physician notifies the medicine department, orthopedic surgeon and anesthesia department and potentially admits the patient. The anesthesiology department can then begin a preoperative assessment and surgical preparations; at the same time, the therapy department is notified and begins to prepare for post-surgery rehabilitation. A fracture Liaison Service adds the patient to the fragility fracture database and begins assessing and treating the patient's osteoporosis. Finally, the discharge planning department begins to work with the team on when the patient can safely discharge from the hospital.
"With all required departments coordinating with one another, many patients may be able to receive surgery the very same day," according to the white paper. The improved communication between providers ultimately streamlines the patient experience. Hospitals with a fragility fracture program often see reduced length of stay, lower infection risk, fewer complications, fewer readmissions, reduced secondary fracture rate and increased patient satisfaction.
Hospitals with 100 hip fracture patients per year or more would benefit most from the program, as there is high enough volume to establish protocols with consistency. Recruiting the right leadership for the program is essential and clinical champions across each service line ensure the program is successful. Then the champions can achieve buy-in from other providers to implement the program, typically over a six-month period.
"In total, a successful fragility fracture program can help hospitals reach the Triple Aim of improved patient experience, better population health and lower costs due to reduced length of stay, better HCAHPS scores and fewer complications and readmissions," according to the whitepaper.