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hip program

Upstate introduces new care model for older adults with hip fractures

Upstate Medical University will implement a new care model for older adults with hip fractures.

The new interdisciplinary approach and collaboration between geriatrics and orthopedics focuses on getting patients in and out of surgery and onto rehabilitation in a more timely manner in order to reduce risk of complications and improve outcomes.

The American Geriatrics Society Ortho CoCare program, which is being introduced at both campuses this month, is a national model being used at hospitals across the country and has been shown to improve patient care while being cost-effective to the hospital.

“We are very excited to launch this program,” said Emil Azer, MD, an assistant professor of orthopedic surgery who specializes in orthopedic trauma. “In these patients, a team effort is required to deliver the best care.  We have synthesized a group of experts from each medical discipline to help these patients reach the best outcome possible.

According to the CDC, 300,000 adults aged 65 or older are hospitalized for hip fractures every year. Older people are more susceptible to fractures as bones become thinner as they age.

“Fragility fractures are much more difficult than fractures in their younger counterparts, and not every orthopedic surgeon has the know-how and training to treat them,” Azer said. “In addition to experts in treating the medical problems of an older population, we are also the only hospital in the region with orthopedic surgeons specially trained to treat all fractures.”

The interdisciplinary program will focus on patients 65 and older who experience a low-velocity hip fracture, the type of fracture that results from a fall.

Sharon Brangman, MD, chair of the Department of Geriatrics at Upstate and SUNY Distinguished Service Professor, said this program assembles everyone involved in the care of such patients in a focused way. These include the geriatric and orthopedic departments as well as anesthesia, emergency providers, hospitalists, nurses, covering providers at night, rehabilitative therapists, dieticians, social workers or case managers, pharmacists, quality and pain service.

“This is an incredible team approach,” Brangman said. “We know that team approaches work very well to take care of older adults.”

The goal is that communication and co-management will reduce time waiting for surgery or rehab, to limit medications that could cause delirium or confusion that could delay surgery and increase time spent by the patient in the hospital. The program aims to reduce the likelihood of readmittance to the hospital.

“Our goal is to improve coordination and overall care for our geriatric fracture patients,” said Lia Fischi, RN, MSN, ONC, clinical lead for Ortho CoCare Program and interim orthopedic program manager. “By improving coordination and collaboration among disciplines, we are standardizing care for our hip fracture patients at both campuses. 

Brangman said research shows that the more quickly a person with a hip fracture gets surgery, has their pain controlled and gets out of bed to start moving again, the better they do.

“We know that the longer older people are immobile, the poorer their outcomes,” she said. “We know how important it is to treat pain. We know how important it is to reduce exposures to medications that can increase their risk for delirium. All of these things can come together to cause a less than optimal outcome. That’s our goal, to reduce anything that could impact a poor outcome.”

Research also shows that hip fractures can result in an increase of morbidities, or complications, as well as mortality. By managing care of these patients more efficiently, patients are more likely to maintain their ability to walk and their independence.

“We think that this is going to be an excellent program to provide to our older adults in Central New York,” Brangman said. “We want to restore people to that level of function they had before, and we don’t want them to lose any ground. These are the things that help people get back to their lifestyle.”


Caption: Orthopedic surgeon Emil Azer, MD, interim Orthopedic Program Manager Lia Fischi and Geriatrics Chair Sharon Brangman, MD, have played key roles in introducing this program at Upstate.