Managing the Geriatric Boom
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Because hip fractures are more common among the elderly and are linked to complications and a high prevalence of comorbidities, Highland runs a geriatric fracture center that has improved outcomes and led to more patient care. The center, which includes orthopedic operating rooms, utilizes early evaluation of patients and ongoing comanagement protocols involving geriatric specialists as well as orthopedic physicians, including hospitalists, Mendelson says.
The teams take “ownership” of the patient, and frequent communication is vital to the interdisciplinary effort, he adds. Geriatric and orthopedic physicians share responsibility for patients’ care throughout hospitalization. Nurses, social workers, physical therapists, occupational therapists, physician assistants, and nutritionists are part of the comanagement team and work to address underlying medical conditions and reduce postoperative complications.
In reports by Mendelson and his colleagues about hip fracture surgeries and treatment at Highland compared to another top hospital with high outcomes, the geriatric fracture center had shorter length of stays, 4.6 to 8.3 days; fewer postoperative infections, 2.3% compared to 19.8%; and fewer complications overall, 30.6% versus 46.3%.
“We contain costs and control quality,” Mendelson says. With a limited number of geriatricians nationwide, he says having hospitalists in the program has ensured better outcomes. “By having a geriatric hospitalist program involved related to fractures, the length of stay certainly is reduced. It makes sense for the patient.”
The hospital is also affiliated with more than 3,800 beds at assisted living and skilled nursing facilities, which serve as a referral base for medical and surgical admissions, he says.
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