Implementing a Geriatric Fracture Program in a Mixed Practice Environment Reduces Total Cost and Length of Stay

Area of Science:

• Geriatric Medicine
• Orthopaedic Surgery
• Healthcare Management

Background:

• Geriatric-orthopaedic co-management models are known to enhance patient outcomes.
• Previous models were often implemented in academic centers with exclusive inpatient geriatric services.
• This study introduces a Geriatric Fracture Program (GFP) in a diverse, pluralistic practice environment.

Purpose of the Study:

• To evaluate the effectiveness of a Geriatric Fracture Program (GFP) in a mixed practice setting.
• To determine if GFP enrollment impacts length of stay (LOS), time to surgery (TTS), and total hospital costs.
• To assess the feasibility of implementing such a program without a dedicated inpatient geriatric service.

Main Methods:

• A multidisciplinary team was formed, led by a geriatric Nurse Practitioner (NP) and a consulting geriatrician.
• Standardized geriatric-focused training and electronic tools were developed based on best practice guidelines.
• Patients aged over 65 with fractures were prospectively enrolled between July 2018 and June 2019.

Main Results:

• Patients in the GFP experienced a significantly shorter median length of stay (4 days vs. 5 days, P < 0.001).
• A trend towards shorter median time to surgery was observed in the GFP group (21.5 hours vs. 25 hours, p = 0.066).
• Mean total hospital costs were significantly lower for GFP patients ($25,323 vs. $29,085, p = 0.022).

Conclusions:

• A geriatric-orthopaedic co-management model can be successfully implemented in complex, mixed practice environments without an inpatient geriatric service.
• The Geriatric Fracture Program (GFP) demonstrates significant reductions in length of stay and total hospital costs.
• The program's success suggests potential for expansion to improve care for the broader geriatric fracture population and achieve further cost savings.