Central Maine Medical Center and Central Maine Orthopaedics, who came together to establish The Orthopaedic Institute of Central Maine five years ago, have developed the state's first hip fracture program focused on helping patients recover sooner.
"A hip fracture is one of the most common injuries that threaten our aging population. It can mean the beginning of the end for an elderly person — a critical moment that turns a life upside down," says Elizabeth Turcotte, the Institute's Director. "Too often, people who were living independently have ended up in a long-term care facility after breaking a hip, never to return home again."
Research shows that patients who are treated quickly after a hip fracture have better outcomes. However, in most healthcare facilities across the country, geriatric hip fracture patients are considered non-urgent cases and have extended waits for surgical care. "Our program ensures that hip fracture patients are seen as a higher priority," Dr. Jeffrey Bush, the OICM Medical Director says. "That means the moment they enter the emergency room and a fracture is detected, they are put on a fast track to surgery."
Approximately 350,000 people with broken hips are treated every year in the United States and given the aging population, that number is expected to rise to 650,000 by 2050. In this state with the nation's highest median age, hip fractures are forecasted to rise in the future. Ninety percent occur in people over the age of 60. Most are women.
Usually, hip fracture treatment has been surgery coupled with weeks or months of bed rest, meaning that elderly patients are likely to develop post-operative complications such as pneumonia, urinary tract infections, blood clots and wound infections, and many are unable to return home or live independently. And 20 to 50 percent die within 12 months, according to national statistics.
A person arriving at a hospital's emergency department with a hip fracture might traditionally be treated as a "non-urgent" patient who might wait 72 hours for surgery, increasing the chances for medical complications. Hospitalization may last up to a week and elderly patients must often be transferred to skilled nursing care facilities.
The new protocol developed by the Orthopaedic Institute of Central Maine, while adhering to tested standards of care, uses a multidisciplinary team approach that reduces variations in care and takes all aspects of a patient's situation into consideration.
The OICM uses an approach called Core Connect CareSM. Each patient, including a hip fracture patient, is assigned a multidisciplinary team, which includes an orthopaedic surgeon, hospitalist, orthopaedic nurse, physical therapist, orthotist, occupational therapist, case manager, social worker and attendant staff. A new role, chief customer officer, was recently created to help guide patients and family members through their OICM experience.
Before a patient with a broken hip arrives at Central Maine Medical Center's emergency room, says Dr. Bush, the emergency response team notifies CMMC, which initiates the Hip Fracture treatment protocol. The ER physician stabilizes the patient, a social worker explains to the patient what to expect, and a hip fracture program orthopedist and hospitalist prepare the patient for surgery, which usually is performed 12 to 24 hours after the injury. Physical therapy is started soon afterward, before the patient leaves the hospital.
"Because patients in our program are in surgery within hours instead of days, there is rarely a need to use narcotics to manage pain," says Dr. Bush. "This means faster and more aggressive physical therapy following surgery, which can lead to a faster recovery. Often, our patients are discharged from the hospital using only over-the-counter medicine to manage pain."
But because these common, debilitating injuries are also preventable, the Hip Fracture Program team tries to help people avoid them. "We are working teach people — before they experience an injury — about common causes, how to prevent and treat osteoporosis, and how to prevent falls," says Dr. Bush.
"And we are also dedicated to changing the patient care paradigm," he adds. "Hip fractures should be a priority in the emergency department, not a 'non-urgent' matter. With that approach, the Program expects to see better outcomes for the hospital and, more importantly, for patients who want nothing more than to live independently in their own homes as long as they possibly can."