Presentation Details
| Gait Expectations: Improved Outcomes with the Implementation of an EMR-Based Fragility Fracture Pathway Urvika Choksey1, 2, 3, Karla Bullon3, Jinsung Kim1, Erica Espinoza2, Rebecca Calabrese2, Daniel Heacock2, Mithil Choksey1, 2, Xintong Zuo1, 2, Mario Nunez2, Deborah Cooke2. 1Yale School of Medicine, New Haven, CT, USA.2Yale New Haven Hospital, New Haven, CT, USA.3Cape Fear Valley Medical Center, Fayetteville, NC, USA |
Abstract
BACKGROUND: Hip fractures in older adults are associated with high morbidity, mortality, functional decline and significant costs to the healthcare system. Fragmented perioperative care and delays in optimization and surgery further worsen outcomes. By standardizing the care of older patients who come in with hip fractures, evaluation can be streamlined and peri-operative outcomes improved.
PURPOSE: This prospective observational study evaluated clinical impact of the EMR-based ERAS Fragility Hip Fracture Pathway at a tertiary center. Outcomes of an index patient treated using the pathway was compared against pre-implementation institutional benchmarks. In addition, aggregate institutional data from the first 12 months of implementation were reviewed, focusing on time to surgery, length of stay, postoperative complications, readmissions and mortality.
RESULTS: For the index case, time to surgery was reduced to 12 hours compared with the historical average of 36 hours. No postoperative thrombotic events, blood transfusions, infections (surgical site, pneumonia, UTI) or delirium occurred, and length of stay was shortened to 3 days compared with the baseline 6–7 days. The patient returned to baseline function at 3 weeks and experienced no 30-day readmission. Institution-wide analysis demonstrated a reduction in time to surgery <24hrs, reduction in length of stay from 6.7 to 5.5 days, 30-day readmission from 17.2% to 10.9% and decrease in 30-day mortality from 6.7% to 3.3%.
CONCLUSIONS: Implementation of the EMR-based Frailty Hip Fracture Pathway resulted in clinically meaningful improvements in outcomes at both patient and systems levels. This study supports the role of standardized multidisciplinary pathways, with the latest evidence-based approaches, as effective innovations to optimize perioperative care for older adults with hip fractures.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: This prospective observational study evaluated clinical impact of the EMR-based ERAS Fragility Hip Fracture Pathway at a tertiary center. Outcomes of an index patient treated using the pathway was compared against pre-implementation institutional benchmarks. In addition, aggregate institutional data from the first 12 months of implementation were reviewed, focusing on time to surgery, length of stay, postoperative complications, readmissions and mortality.
RESULTS: For the index case, time to surgery was reduced to 12 hours compared with the historical average of 36 hours. No postoperative thrombotic events, blood transfusions, infections (surgical site, pneumonia, UTI) or delirium occurred, and length of stay was shortened to 3 days compared with the baseline 6–7 days. The patient returned to baseline function at 3 weeks and experienced no 30-day readmission. Institution-wide analysis demonstrated a reduction in time to surgery <24hrs, reduction in length of stay from 6.7 to 5.5 days, 30-day readmission from 17.2% to 10.9% and decrease in 30-day mortality from 6.7% to 3.3%.
CONCLUSIONS: Implementation of the EMR-based Frailty Hip Fracture Pathway resulted in clinically meaningful improvements in outcomes at both patient and systems levels. This study supports the role of standardized multidisciplinary pathways, with the latest evidence-based approaches, as effective innovations to optimize perioperative care for older adults with hip fractures.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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