Geriatric Traumatology:The effectiviness of integrated orthogeriatric treatment on 1-year outcome in frail elderly with hip fracture

In an elderly person, a hip fracture can have severe consequences for the patient due to the risk of loss of mobility and early death. As the population ages, the number of patients with hip fractures will increase. The treatment is complex due to the occurrence of several disorders, malnutrition, memory issues, the use of various drugs, regular falls, bone decalcification and infirmity. The risk of complications and death is significant and is linked to high treatment costs. To improve the results of the treatment and efficacy, surgeons and orthopedists have developed various treatment models. In the Netherlands, the Center for Geriatric Traumatology (CvGT ), where the integrated orthogeriatric treatment model is used, was established in 2008. This model distinguishes itself from the joint treatment responsibility of the trauma surgeon/orthopedist and the geriatrician. Starting at the Emergency Ward, both specialties work together intensively with the support of a multidisciplinary team, and the emphasis is on preventing complications and loss of function.Since not much research has been conducted into the effectiveness of this treatment model so far, the recovery of elderly patients with a hip fracture was studied at the CvGT.Compared to the period before 2008, CvGT patients developed significantly fewer complications, and the duration of admission decreased with significantly fewer readmissions within 30 days. Significantly more patients with a hip fracture survived the first year. After integrated orthogeriatric treatment, there appears to be a connection to better short- and long-term treatment results for elderly patients with a hip fracture

Geriatric Traumatology:The effectiviness of integrated orthogeriatric treatment on 1-year outcome in frail elderly with hip fracture

In an elderly person, a hip fracture can have severe consequences for the patient due to the risk of loss of mobility and early death. As the population ages, the number of patients with hip fractures will increase. The treatment is complex due to the occurrence of several disorders, malnutrition, memory issues, the use of various drugs, regular falls, bone decalcification and infirmity. The risk of complications and death is significant and is linked to high treatment costs. To improve the results of the treatment and efficacy, surgeons and orthopedists have developed various treatment models. In the Netherlands, the Center for Geriatric Traumatology (CvGT ), where the integrated orthogeriatric treatment model is used, was established in 2008. This model distinguishes itself from the joint treatment responsibility of the trauma surgeon/orthopedist and the geriatrician. Starting at the Emergency Ward, both specialties work together intensively with the support of a multidisciplinary team, and the emphasis is on preventing complications and loss of function.Since not much research has been conducted into the effectiveness of this treatment model so far, the recovery of elderly patients with a hip fracture was studied at the CvGT.Compared to the period before 2008, CvGT patients developed significantly fewer complications, and the duration of admission decreased with significantly fewer readmissions within 30 days. Significantly more patients with a hip fracture survived the first year. After integrated orthogeriatric treatment, there appears to be a connection to better short- and long-term treatment results for elderly patients with a hip fracture

Transparency in hip fracture recovery over institutional boundaries:The transmural monitoring pathway

Objectives: To develop a transmural pathway for healthcare professionals across institutions to monitor the recovery of hip fracture patients. The secondary objectives were to evaluate the pathway's feasibility and initial outcomes. Design: Prospective cohort study. Method: Stakeholders of the hospital and geriatric rehabilitation institutions implemented a transmural monitoring pathway in which different geriatric health domains were monitored during three phases: The in-hospital, inpatient rehabilitation, and outpatient follow-up phase. The outcomes for the first 291 patients and the feasibility of the pathway were evaluated. If the outcomes of the clinimetrics significantly improved over time, progress in functional recovery was assumed. Feasibility was assessed according to the rate of adherence to the clinimetric tests. Results: During the in-hospital phase, patients showed a decline in functional level (the Katz index of independence in Activities of Daily Living (Katz-ADL) pre-fracture vs. discharge: 0 (0–2) vs. 4 (4–5), P &lt; 0.001). Patients, in which 78.6% (n = 140) had cognitive impairment and 41.2% had malnutrition, showed the most progress (Katz-ADL 2 (1–3)) during the inpatient rehabilitation phase. In the outpatient follow-up phase, recovery remained ongoing, but most patients had not returned to their pre-fracture functional levels (Katz-ADL 1 (1–3)). The pathway feasibility during the first phase was excellent (&gt;85%), whereas room for improvement existed during other phases (&lt;85%). Conclusion: The transmural monitoring pathway provides insight into the entire recovery process for all involved healthcare professionals. Patients showed the most progress during the rehabilitation phase. The pathway feasibility was excellent during the in-hospital phase, but improvements could be made during other phases.</p

Early Warning Scores to Support Continuous Wireless Vital Sign Monitoring for Complication Prediction in Patients on Surgical Wards:Retrospective Observational Study

Background: Wireless vital sign sensors are increasingly being used to monitor patients on surgical wards. Although early warning scores (EWSs) are the current standard for the identification of patient deterioration in a ward setting, their usefulness for continuous monitoring is unknown.Objective: This study aimed to explore the usability and predictive value of high-rate EWSs obtained from continuous vital sign recordings for early identification of postoperative complications and compares the performance of a sensor-based EWS alarm system with manual intermittent EWS measurements and threshold alarms applied to individual vital sign recordings (single-parameter alarms).Methods: Continuous vital sign measurements (heart rate, respiratory rate, blood oxygen saturation, and axillary temperature) collected with wireless sensors in patients on surgical wards were used for retrospective simulation of EWSs (sensor EWSs) for different time windows (1-240 min), adopting criteria similar to EWSs based on manual vital signs measurements (nurse EWSs). Hourly sensor EWS measurements were compared between patients with (event group: 14/46, 30%) and without (control group: 32/46, 70%) postoperative complications. In addition, alarms were simulated for the sensor EWSs using a range of alarm thresholds (1-9) and compared with alarms based on nurse EWSs and single-parameter alarms. Alarm performance was evaluated using the sensitivity to predict complications within 24 hours, daily alarm rate, and false discovery rate (FDR). Results: The hourly sensor EWSs of the event group (median 3.4, IQR 3.1-4.1) was significantly higher (P&lt;.004) compared with the control group (median 2.8, IQR 2.4-3.2). The alarm sensitivity of the hourly sensor EWSs was the highest (80%-67%) for thresholds of 3 to 5, which was associated with alarm rates of 2 (FDR=85%) to 1.2 (FDR=83%) alarms per patient per day respectively. The sensitivity of sensor EWS–based alarms was higher than that of nurse EWS–based alarms (maximum=40%) but lower than that of single-parameter alarms (87%) for all thresholds. In contrast, the (false) alarm rates of sensor EWS–based alarms were higher than that of nurse EWS–based alarms (maximum=0.6 alarm/patient/d; FDR=80%) but lower than that of single-parameter alarms (2 alarms/patient/d; FDR=84%) for most thresholds. Alarm rates for sensor EWSs increased for shorter time windows, reaching 70 alarms per patient per day when calculated every minute.Conclusions: EWSs obtained using wireless vital sign sensors may contribute to the early recognition of postoperative complications in a ward setting, with higher alarm sensitivity compared with manual EWS measurements. Although hourly sensor EWSs provide fewer alarms compared with single-parameter alarms, high false alarm rates can be expected when calculated over shorter time spans. Further studies are recommended to optimize care escalation criteria for continuous monitoring of vital signs in a ward setting and to evaluate the effects on patient outcomes.</p