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Archives of Orthopaedic and Trauma Surgery

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01-03-2019 | Trauma Surgery

Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures

Authors: Christina Roll, Sandra Tittel, Malte Schäfer, Janosch Burkhardt, Bernd Kinner

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2019

Abstract

Objective

The objective of the current study was to evaluate the effect of a quality management system on treatment and care delivery of proximal femoral fractures. Specifically, our hypothesis was that the “plan–do–check–act (PDCA)” philosophy of the ISO 9001 quality management system results in a continuous improvement process.

Methods

1015 proximal femoral fractures were prospectively included into a hip fracture database over a 5-year period, after a restructuring process with implementation of clinical pathways and standard operation procedures. A close and structured ortho-geriatric co-management (certified ortho-geriatric center) was the basis for treatment. ISO 9001 certification was granted for the first time in 2012. Procedural and patient outcome parameters were analyzed by year and evaluated statistically using SPSS 25.0.

Results

In both categories (procedural and outcome) significant changes could be detected during the 5-year period, e.g., significant reduction of time to surgery for the first 2 years, improvement in discharge management, and reduction of surgical complications. However, no significant changes could be demonstrated for mortality or internal complications such as pneumonia, urinary tract infections, or postoperative delirium. However, the incidence of the latter was already on a very low level at the onset of the quality improvement process.

Conclusion

We could show a relevant and continuous improvement of several quality indicators during a 5-year period after implementation of a quality management system based on the PDCA philosophy for the treatment of proximal femoral fractures in elderly patients. However, other parameters (internal complications, cost-effectiveness, etc.) need our close attention in the future.

Diabetes mellitus with end-organ damage, liver disease, moderate to severe, malignancy, moderate to severe chronic kidney disease, chronic heart failure, myocardial infarction, COPD, dementia, hemiplegia. Corresponding to a Charleston Comorbidity Index of 4 and above and an estimated 10-year survival of less than 50%, the geriatrician responsible decided upon inclusion and exclusion.

Early geriatric rehabilitation program: geriatric and social assessment, weekly teem meeting, activating care of specially trained nursing staff, 20 units of physical and occupational therapy during a 14-day period.

Data not presented.

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Title: Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures
Authors: Christina Roll
Sandra Tittel
Malte Schäfer
Janosch Burkhardt
Bernd Kinner
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 3/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3086-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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