An Effective Team Approach to Improve Postoperative Hip Fracture Care

作者：Piziak Veronica K^*; Rajab Mohammad H

来源：Journal of Orthopaedic Trauma, 2011, 25(2): 72-75.

DOI：10.1097/BOT.0b013e3181db703c

• calcium
• hip fracture
• vitamin D

Objective: To develop an initiative using standardized discharge orders to improve the posthip fracture care of patients aged 50 years or older.
Design: Prospective nonrandomized study.
Setting: Hospital orthopaedic service.
Participants: Patients at our institution older than age 50 years sustaining a hip fracture who were followed for at least 6 months and qualified for osteoporosis medication.
Intervention: The endocrinology and orthopaedic areas agreed to add calcium/vitamin D supplementation, a dual-energy x-ray absorptiometry scan request, and a consult with endocrinology to the hospital discharge orders.
Outcome Measures: The proportions of patients using calcium or bisphosphonate before and after the intervention were compared using the McNemar test. The designated level of significance was 0.05.
Results: Originally, 37 of 137 patients were taking calcium/vitamin D supplements. Following this initiative, 92 of 137 were taking the supplement (P < 0.0001). Seventeen of 137 patients were taking bisphosphonate initially and 65 of 137 after the initiative (P < 0.0001). After the initiative, 100% of the discharged patients were offered calcium/vitamin D, a dual-energy x-ray absorptiometry scan, and an endocrinology appointment. All of the patients who reported for the endocrinology consult appointment were offered bisphosphonate therapy. Eighty-two patients kept the appointment for the dual-energy x-ray absorptiometry scan, and 54 saw the endocrinologist.
Conclusion: The addition of a calcium/vitamin D supplement and an endocrinology appointment to the hospital discharge orders was an effective method of improving treatment and enhancing compliance.

• 出版日期2011-2