多学科努力加强对老年髋部骨折患者的医疗护理

作者：NursingResearch护理研究前沿

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A multidisciplinary effort to improve care for older patients who arrive at the emergency room with a hip fracture has decreased the time before they have surgery, shortened hospital stays, and resulted in better follow-up care, UT Southwestern physicians reported in Geriatric Nursing.

In February 2021, UTSW launched an orthopedic surgery fracture liaison service, Returning Seniors to Orthopedic Excellence (RESTORE), focused largely on prioritizing early pain management and reducing time to surgery for geriatric patients with hip fractures. A team led by Megan Sorich, D.O., Assistant Professor of Orthopedic Surgery, then integrated the RESTORE program with the existing nursing program – Nurses Improving Care for Healthsystem Elders (NICHE) – which aims to standardize early ambulation, delirium assessment and management, hospital room protocols for better orientation and healing, and improve follow-up visit adherence.

Dr. Sorich, a geriatric orthopedic surgeon and first author of the article, said the time is right for more collaborative care of hip fractures, the most common life-altering orthopedic injury among older adults. More than one-third of women living until age 80 will sustain a hip fracture.

As our population continues to age, more vulnerable patients will need better managed care, and better safety nets. By putting programs like this in place, we hope that we can help other institutions deliver this as well."

Megan Sorich, Assistant Professor, Orthopedic Surgery, UT Southwestern Medical Center

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Under RESTORE and NICHE, the collaborative care team for hip fracture patients includes physicians in emergency medicine, internal medicine, geriatrics, anesthesiology, and pain management, as well as nutritionists, physical and occupational therapists, discharge planning coordinators, geriatric resource nurses and geriatric patient care associates.

Data on 117 patients treated since the RESTORE program launched shows that time to surgery declined from 44 hours to 18, and attendance at post-discharge follow-up visits rose from 40% to 70%, compared to a 30% national average, according to the article. Length of stay dropped from 8.72 days to 7.6 days.

Dr. Sorich said other hospitals could benefit by implementing similar programs. She said the key to success, after buy-in and support from hospital administrators, is having stakeholders in the geriatric medicine team as well as orthopedic surgery team invested in the program from the start. It is also a tremendous advantage to have all hip fracture patients located on the same floor, which UTSW has done.

"This ensures continuity of care between the nurses, physical therapists, occupational therapists, care coordinators as well as the hospital team," she said.

全文翻译（仅供参考）

UT Southwestern 的医生在Geriatric Nursing中报告说，一项多学科的努力旨在改善对因髋部骨折而到达急诊室的老年患者的护理，缩短了他们手术前的时间，缩短了住院时间，并带来了更好的后续护理MangoPro。

2021 年 2 月，UTSW 推出了一项骨科手术骨折联络服务，即让老年人恢复骨科卓越 (RESTORE)，主要侧重于优先考虑早期疼痛管理和减少老年髋部骨折患者的手术时间MangoPro。由骨科外科助理教授 Megan Sorich 领导的团队随后将 RESTORE 计划与现有的护理计划 - 改善医疗系统老年人护理 (NICHE) 的护士 - 旨在标准化早期行走、谵妄评估和管理、病房更好的定向和康复方案，并提高随访的依从性。

Sorich 博士是一名老年骨科外科医生，也是该文章的第一作者，他说现在是对髋部骨折进行更多协作治疗的时候了，髋部骨折是老年人中最常见的改变生活的骨科损伤MangoPro。超过三分之一的活到 80 岁的女性会出现髋部骨折。

随着我们的人口继续老龄化，更多易受伤害的患者将需要更好的管理护理和更好的安全网MangoPro。通过实施这样的计划，我们希望我们也可以帮助其他机构实现这一目标。”

Megan SorichMangoPro，犹他州西南医学中心整形外科助理教授

在 RESTORE 和 NICHE 下，髋部骨折患者的协作护理团队包括急诊科、内科、老年科、麻醉科和疼痛管理的医生，以及营养师、物理和职业治疗师、出院计划协调员、老年资源护士和老年患者照顾同事MangoPro。

自 RESTORE 计划启动以来接受治疗的 117 名患者的数据显示，手术时间从 44 小时缩短到 18 小时，出院后随访的出席率从 40% 上升到 70%，而全国平均水平为 30%MangoPro。文章。停留时间从 8.72 天下降到 7.6 天。

Sorich 博士说，其他医院也可以通过实施类似的项目而受益MangoPro。她说，在得到医院管理人员的支持和支持后，成功的关键是让老年医学团队和骨科手术团队的利益相关者从一开始就投资该项目。将所有髋部骨折患者都放在同一楼层也是一个巨大的优势，UTSW 已经做到了。

“这确保了护士、物理治疗师、职业治疗师、护理协调员以及医院团队之间的护理连续性，”她说MangoPro。

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