Valerie MacDonald RN BSN MSN ONC Janet McMullan, RN, BScN, MN Rhona McGlasson PT MBA

Transcription

1 Valerie MacDonald RN BSN MSN ONC Janet McMullan, RN, BScN, MN Rhona McGlasson PT MBA

2 Bone and Joint Decade: : countries Key strategies: Raise awareness of growing burden of MSK disorders Empower patients to participate in own care Promote cost-effective prevention and treatment Advance research to improve prevention and treatment 2

3 Significance of Problem ~ 30,000 Canadians hospitalized each year for hip fractures: Most are over 65 years - 502/100,000 seniors Significant mortality (18-36% within 1 year), co-morbidity and loss of independence (CIHI Health Indicators Report, 2007; Wiktorowicz et al., 2001)) 3

4 Cost to healthcare system: $27,000/patient/per year Long acute care stays (19 to 24 days) Long term care (LTC) cost $44K vs $21K (CIHI Health Indicators Report, 2007; Wiktorowicz et al., 2001)) 4

5 National Hip Fracture Video Conference (December 2010): Towards a National Hip Fracture Model of Care and Toolkit: Bringing Partners/Stakeholders Together ½ day video conference 9 Expert Speakers in aspects of Hip Fracture Care from across Canada 49 sites across Canada Funded CIHR Musculoskeletal Health & Arthritis (MHA) Planning and Dissemination Grant $10,000 5

6 National Hip Fracture Strategy Phases I, II and III (2011): Identify leaders across the continuum to summarize evidence. Develop Knowledge Translation Network in each province Leaders review/revise content with Network. Funded Canadian Orthopaedic Care Strategy Group (COCSG) $45,000 6

7 Dr. Jim Wasdell Orthopaedic Surgery Dr. Lauren Beaupre- Rehabilitiation Valerie Zellemeyer Preop/OR Dr. Nick Lo Anaesthesiology Valerie MacDonald Immediate postop Dr. Joanie Sims Gould Care Transitions Janet McMullen geriatric focus Osteoporosis Canada Rhona McGlasson- Bone & Joint Canada 7

8 National Model of Care for Hip Fracture PATIENT /FAMILY SELF CARE Hip Fracture HOME With Follow-up 10% Non Weight Bearing 5% Often >28 days post op COMMUNITY Home/ Retirement Setting Independent Living SURGERY Pre-op Medical Stability Hip Fracture Fixation for wt. bearing IMMEDIATE CARE Acute care Post Op Medical Stabilization Early mobilization FUNCTIONAL RECOVERY Inpatient active rehabilitation: Acute /sub-acute care Inpatient Rehab Geriatric program Other COMMUNITY Home/Retirement setting with follow-up care: Homecare Outpatient Long term care LONG TERM CARE <48 Hours 0-5 days post op 5-28 days post op 75% Pts return to pre living LONG TERM CARE 20% Slow Stream Rehab 15% Often >28 days post op Adapted from BJHN 2008, Mahomed et al., 2008; McGilton et al., 2009; BOA, 2007; SIGN, 2002 PREVENTION, DETECTION AND MANAGEMENT OF RISK PREVENTION OF FUTURE FRACTURE - OSTEOPOROSIS, FALLS MANAGEMENT 8

9 National Hip Fracture Strategy Multiple interdisciplinary Teleconferences. Consensus on Core Model of Care; Synthesis of Toolkit Funded Canadian Orthopaedic Care Strategy Group (COCSG) $45,000 9

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11 Phase IV ( ): Two National Meetings Implementation of best practice initiative in 10 provinces Final report for submission April 2013 Funded Health Canada $1,800 for ; $7,200 for & MHA Planning and Dissemination Grant $19,000 11

12 Released June 2011 Best practice Evidence based Consensus where evidence not available Focus Discharge Home Covers the continuum of care Pre operative (ED) Surgery Post operative Functional recovery (rehabilitation) 12

13 Timely OR is a moral and financial imperative. LOS, complications and mortality increase after 24 hours. Hommel, 2011

14 Age related changes Co-morbid conditions Coping strategies Care Supports Environment

15 Staff need to be both geriatric & orthopaedic surgery experts. Adverse events postop are foreseeable & often preventable. Proactive focus to prevent, detect & manage risks/problems is essential. Optimize function & build family care giver capacity for timely return home. Apply care transitions model start in ER.

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17 Often medically unstable in the first 72 hrs postop. Geriatric ortho medical coverage & nurses with high acuity skills best suited to meet care needs. Adequate nutrition, frequent mobility & toileting, starting Day 0 or 1, are essential for rapid recovery. Interdisciplinary rehab focus & care assist staffing for workload.

18 PATIENT Optimal function, minimize adverse events, timely return home Prepared Proactive Practice Team Data tracked & reported to team Geri ortho proactive focus Decision supports Staffing Model Care Transitions

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