Perso An. Geri-O. Objectives: fragility fracture. AL SUPPORT. presentation.

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1 10 th Annual Spring Conference Arizona Geriatrics Society Perso on-centered Care: An Interprofessional Panel Ana Sanguineti, MD Geri-O Ortho Hip Fracture Consult Service Banner Univer rsity Medical Center Learning Objectives: Describe an interdisciplinary servicee that optimizes transitions after fragility fracture. Describe post-discharge fragility fracture clinicc to reduce future fractures. DISCLOSURE OF COMMERCIA AL SUPPORT Ana Sanguineti, MD does not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services discussed in this presentation. The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent 2017 Arizona Geriatrics Society All Rights Reserved 1

2 Person Centered Care in the Inpatient Setting Ana Sanguineti, M.D. Professor of Clinical Medicine Director of Geri Ortho Hip Fracture Service Section of Geriatric, General and Palliative Medicine Department of Medicine Banner University Medical Center- Tucson I have no financial disclosures. Objectives Describe an interdisciplinary geriatric service that optimizes care after a fragility fracture Identify the different elements in geriatric inpatient management that affect outcomes, minimize iatrogenic injury and functional decline Describe additional developments for patient care following discharge 2

3 Impact of Hip Fractures About 350,000 hip fractures in USA yearly Number of hip fractures increase with age 1 year mortality women 20%, men 25% 75% hip fractures occur in women Fractures associated with high incidence of delirium Hip Fracture Service-Concept Friedman et.al;geriatric Co-Management of Proximal Femur Fractures; JAGS 56: , 2008 Fragility hip fractures occur commonly in our geriatric population Prevalence of multiple comorbidities and complications argue for co-managed care by geriatricians and orthopedic surgeons Co-managed services have resulted in shorter length of stay, fewer medical complications and better functional status Hip Fracture Service- Concept Create a program that Evaluates patients early Has Ongoing co-management: geri-ortho Is Geriatric- focused care Has Early discharge planning Involves multiple disciplines for successful management PT/OT, case manager, pharmacist, geriatrician, orthopedics, anesthesiologist 3

4 Goals of Hip Fracture Service Early surgery Decrease inpatient complications Delirium, pressure ulcers, pneumonia, coronary events Early postop mobility Control pain Early discharge Key provisions of co-managed services Orthopedic surgeons and geriatricians communicate daily about patient care Geriatricians optimize care directed towards transition to rehab facility Ward with staff trained to identify delirium Fragility fractures linked to osteoporosis for subsequent treatment to prevent the second fracture Turning Concept into Reality our experience: Our patients receive personalized care We risk-stratify our patients using NSQIP We identify frail and malnourished patients early We review home and inpatient medications for safety and efficacy We put measures into place to reduce delirium 4

5 Our experience, cont. Postoperative complications are minimized or recognized early Our patients receive patient education on their osteoporosis and are directed to our Fragility Fracture Outpatient Clinic for treatment Our service is protocol-driven Results Improved communication and cooperative efforts with our surgeons Early recognition and treatment of delirium Prevention of complications through better understanding of aging physiology Prompt physical therapy and transition to rehabilitation References FriedmanSM,MendelsonDA,Kates SL et.al.geriatric Co- Management of Proximal Femur Fractures: Total Quality management and Protocol-Driven Care Result in Better Outcomes for a Frail Patient Population.JAGS 56: ,2008. Interdisciplinary Hip Fracture Improvement Team. Hip Fracture Management Protocol. University of Missouri Health Care, Columbia, MO Mendelson DA,Friedman SM. Principles of Comanagement and the Geriatric Fracture Center.Clin Geri Med- Fragility Fractures;2014,May,vol 30,No 2. 5

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