Using a collaborative approach to reduce postoperative complications for hip-fracture patients: a three-year follow-up.
BACKGROUND
To reduce perioperative complications for hip fracture, (1) patients were assigned admitting service using a simple clinical algorithm, (2) evidence-based guidelines and order sets were implemented for perioperative care; (3) a nurse specialist facilitated adherence to evidence-based interventions and mobility goals; and (4) patients and families were given an educational brochure highlighting the daily hospital course.


METHODS
A case series with pre/post intervention comparison was conducted for all patients with hip fracture (preintervention n = 97, postintervention n = 589) at 9 months before and 33 months after the intervention.


RESULTS
The algorithm assigned approximately one-third of patients to each of the three general services, with few to subspecialty services. Miscellaneous complications were almost eliminated, and significant reductions were observed in the proportion of patients with iatrogenic complications and postprocedure hemorrhage and hematoma. The percentage of patients with any postoperative complication fell from almost 60% to less than 10% by the end of the study.


CONCLUSIONS
This study provides preliminary data from which to investigate the effectiveness of collaborative approaches to management on the outcomes of care for medically complex and geriatric surgical patients.
Moran
William P
WP
Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, USA. moranw@musc.edu
Chen
G John
GJ
Watters
Carol
C
Poehling
Gary
G
Millman
Franklyn
F
D003299:Cooperative Behavior; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D009657:North Carolina / Q000453:epidemiology; D019982:Organizational Case Studies; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011787:Quality of Health Care