An effective team approach to improve postoperative hip fracture care.
OBJECTIVE
To develop an initiative using standardized discharge orders to improve the posthip fracture care of patients aged 50 years or older.


METHODS
Prospective nonrandomized study.


METHODS
Hospital orthopaedic service.


METHODS
Patients at our institution older than age 50 years sustaining a hip fracture who were followed for at least 6 months and qualified for osteoporosis medication.


METHODS
The endocrinology and orthopaedic areas agreed to add calcium/vitamin D supplementation, a dual-energy x-ray absorptiometry scan request, and a consult with endocrinology to the hospital discharge orders.


METHODS
The proportions of patients using calcium or bisphosphonate before and after the intervention were compared using the McNemar test. The designated level of significance was 0.05.


RESULTS
Originally, 37 of 137 patients were taking calcium/vitamin D supplements. Following this initiative, 92 of 137 were taking the supplement (P < 0.0001). Seventeen of 137 patients were taking bisphosphonate initially and 65 of 137 after the initiative (P < 0.0001). After the initiative, 100% of the discharged patients were offered calcium/vitamin D, a dual-energy x-ray absorptiometry scan, and an endocrinology appointment. All of the patients who reported for the endocrinology consult appointment were offered bisphosphonate therapy. Eighty-two patients kept the appointment for the dual-energy x-ray absorptiometry scan, and 54 saw the endocrinologist.


CONCLUSIONS
The addition of a calcium/vitamin D supplement and an endocrinology appointment to the hospital discharge orders was an effective method of improving treatment and enhancing compliance.
Scott & White Memorial Hospital and Clinic, The Texas A&M University Health Science Center College of Medicine, Temple, TX, USA. vpiziak@swmail.sw.org
Veronica K
VK
Piziak
Mohammad H
MH
Rajab
D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D005260:Female; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data; D011859:Radiography; D020127:Recovery of Function; D013781:Texas; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents