title: Universal Postoperative Hip Instruction Protocol for Rehabilitation in Rural Skilled Nursing Facilities.
abstract: OBJECTIVE
  Hip fractures among the elderly increase the incidence of mortality and other health-related complications, lead to poor quality of life, and create major economic challenges. Elderly individuals often reside in rural skilled nursing facilities (SNFs) for rehabilitation after undergoing surgical fixation for a hip fracture. Orthopedic providers (OPs) can develop protocols that will encourage continuity of postoperative orthopedic follow-up care, guiding and educating SNF staff in best practices, and encouraging regular communication between SNF staff and OPs. The purpose of this article is to describe how an orthopedic practice developed a universal postoperative hip instruction protocol (UP-HIP) to promote a streamlined approach to postoperative follow-up assessment and rehabilitation for the elderly residing in rural SNFs. The overall goal of the UP-HIP is to provide the OP with assessment findings remotely and avoid putting frail elderly patients at risk by physically transporting them to and from follow-up appointments with the OP.
  
  
  METHODS
  Orthopedic clinic setting and rural SNFs.
  
  
  CONCLUSIONS
  Comprehensive postoperative protocols focused on elderly patients with hip fracture in rural SNFs serve to improve remote communication during the rehabilitation phase and guide SNF in a coordinated approach to postoperative follow-up care. Future recommendations include the addition of telehealth technology to allow for remote real-time visual assessments by the OP while the elderly patient with hip fracture remains in the SNF environment.
  
  
  CONCLUSIONS
  The UP-HIP allows the OP and case manager to ensure continuity of postoperative care by conducting remote follow-up postoperative visits with elderly patients with hip fracture while they remain in the rural SNF setting. Comprehensive evidence-based protocols assist OPs and case managers with remotely monitoring rehabilitation progress in the rural SNF setting more efficiently and consistently. Telehealth technology added to evidence-based protocols enables the OP and case manager to conduct real-time visual assessments of the patient without the patient having to leave the rural SNF setting.
authors.affiliation: Mary Atkinson Smith, DNP, MSN, BSN, is a board certified nurse practitioner and registered nurse first assistant at Starkville Orthopedic Clinic, in addition to the cofounder of Starkville Orthopaedic Clinic located in a rural community of Mississippi. She has additional certifications as an orthopedic nurse practitioner and in perioperative nursing. Dr. Smith is also an assistant professor and assistant program director for South University College of Nursing and Public Health. She also serves as the Education and Program Director for the Mississippi Rural Health Association. William Todd Smith, MD, is a board certified orthopedic surgeon and is also a cofounder of Starkville Orthopaedic Clinic. Dr. Smith also has a subspecialty certification in sports medicine. He completed an orthopedic surgery residency at the University of Mississippi Medical Center in Jackson, MS. Dr. Smith provides orthopedic care to the rural community of Starkville, MS, and residents in the surrounding counties. Marietta Stanton, PhD, MSN, BSN, is a board certified nurse practitioner and a certified case manager. She is currently a professor of nursing at the Capstone College of Nursing in Tuscaloosa, AL. Dr. Stanton has served on active duty as the Senior Case Manager for Clinical Operations, Southeast Regional Medical Command. She has also played an instrumental role in developing the Capstone College of Nursing's Masters' Program in Case Management and Leadership for rural populations.
authors.forename: Mary Atkinson
authors.initials: MA
authors.lastname: Smith
authors.forename: William Todd
authors.initials: WT
authors.lastname: Smith
authors.forename: Marietta
authors.initials: M
authors.lastname: Stanton
mesh_terms: D002985:Clinical Protocols; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D011184:Postoperative Period; D012051:Reimbursement Mechanisms; D019035:Rural Health Services / Q000458:organization & administration*; D012866:Skilled Nursing Facilities / Q000458:organization & administration*; D017216:Telemedicine