It’s an all-too-common scenario: An elderly person falls, fractures a hip, and must wait days for surgery. In the leadup to surgery and in the weeks that follow, it can be just as common for the patient to experience an overall decline in health and function. At Overlook Medical Center, however, our doctors have cultivated a greater culture of urgency for treating hip fractures. This has resulted in better patient outcomes, and mortality rates that are half the national average.
Unlike other parts of the body, hip fractures cannot be treated without surgical intervention. Through the hip fracture program at Overlook, these fractures are treated like emergencies and patients are operated on within 48 hours – most within 24 hours, says orthopedic surgeon Jeffrey Leary, MD, director of fracture services and lead physician for the comprehensive joint replacement program at Overlook Medical Center. A member of the hip fracture team is always on call to evaluate these patients when they come in through the emergency department. Additionally, an operating room is on hold for hip fracture surgery every afternoon, so that it is readily available if needed. “The sooner we get patients to the OR, the better they do. That’s easy to say, but how do you do it? Most hospitals don’t. You need a team approach.”
To that end, says board-certified (by the American Board of Internal Medicine) internist Gina LaCapra, MD, FACP, medical leader of the hip fracture program, Overlook created a team to improve communication and care with these patients. “One of the clear things we identified is that there are so many people in the mix: the emergency department, internal medicine, orthopedics, anesthesiology, physical therapy. We had to figure out best practices for who should do what and who should pull it all together,” says Dr. LaCapra. “We mapped out a whole process from detail to detail to achieve the best outcomes. The team quickly identifies the patient’s medical problems and determines how these may impact the surgery. Treating those issues in an efficient manner enables patients to get their surgery as soon as possible. Closely following these patients afterward helps reduce complications. Getting patients back to functional life – that’s the goal.”
Because hip fractures tend to occur in elderly people who are fragile, and because this patient population is inherently more complicated to manage due to multiple medical conditions, it is often necessary to first get patients to the point where they are optimized for surgery. “The more we can optimize patients going into surgery, the better they will withstand surgery and the better they will do after surgery,” says Dr. Leary.
The connected team approach of the hip fracture program helps to facilitate optimal outcomes in a streamlined fashion. “We can see from the results that this is working,” says Dr. Leary. “You can go to many other places for surgery, but you’re going to sit for three or four days before you get fixed. That’s suboptimal. We are doing this better than the best hospitals out there. Where you go for orthopedic care matters.”
Drs. LaCapra and Leary are part of Atlantic Medical Group, a multispecialty network of health care providers.