A multidisciplinary approach to improve the quality of care for patients with fragility fractures

Fragility fractures have become a worldwide epidemic associated with significant morbidity and mortality. As the world population ages, the number of patients that experience these fractures is also expected to rise. A multidisciplinary team was assembled that was coordinated by the Acute Inpatient Medical Service and included orthopedic surgeons, geriatricians, anesthesiologists, cardiologists, nurses, trauma surgeons, emergency medicine physicians, physiatrists, and physical therapists. This team was formed with the expectation that geriatric fragility fracture complications, specifically hip fractures, could be reduced by identifying and implementing best practices using guidelines from the American Academy of Orthopedic Surgery and those from the International Geriatric Fracture Society.

We implemented a clinical pathway with a standardized approach with reduction in care variation and followed that by instituting performance improvement measures. The difference in outcome measurements as reported by TQIP for the year prior to implementation and the year following creation of the fragility fracture program was evaluated.

Benchmarking data demonstrated improved outcomes for patients with fragility fractures. Length of stay was significantly below national average, mortality remained below national average, and complication rates for UTIs and pressure ulcers were both reduced from 2014 to 2015 and below the national average.

The clinical pathway we adopted for the care of patients with fragility fractures has resulted in reduced lengths of stay, below average mortality, and improved discharge disposition.