scholarly journals 284 Improving Adherence to Irish Hip Fracture Database Standards 1 and 2

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Siofra Hearne ◽  
Hannah Smyth ◽  
Pheadra Monahan ◽  
Hugh McGowan ◽  
Shirley Timmins ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Health Professionals ◽  
Older Patients ◽  
Orthopaedic Surgery ◽  
Oral Anticoagulants ◽  
Poor Performance ◽  
Working Hours ◽  
Close Collaboration ◽  
Allied Health Professionals ◽  
Orthopaedic Ward

Abstract Background The Irish Hip Fracture Database (IHFD) National Report 2017 demonstrated poor performance across all six IHFD standards in our hospital. For the purpose of this study we focused on standards 1 and 2. IHFD standard 1: All patients with hip fracture should be admitted to an acute orthopaedic ward within 4 hours of ED presentation/ brought directly to theatre from ED within 4 hours, and IHFD standard 2: All patients with hip fracture who are medically fit should have surgery within 48 hours of admission and during normal working hours. Methods We examined IHFD standards 1 and 2 from August 2017-January 2018 and August 2018-January 2019 after the appointment of an orthogeriatrician and use of the first Hip Fracture Pathway in August 2018. We also analysed data collected from February-April 2019 after amendment of the hip fracture pathway for patients presenting to the ED. Results IHFD Standard 1: From August to January 2017, 2.5% of patients were admitted to an orthopaedic ward within 4 hours versus 18.1% in 2018. IHFD Standard 2: in 2017, 64.8% underwent surgery within 48 hours during working hours, versus 65.3% in 2018. From February to April 2019, 32.1% of patients were admitted to an orthopaedic ward within 4 hours (IFHD 1) and 56.6% of patients underwent surgery within 48 hours and during working hours (IFHD 2). Conclusion Close collaboration between Emergency Medicine, Orthopaedic Surgery, Radiology, Nursing colleagues, Allied Health Professionals and Orthogeriatrics and amendment of the Hip Fracture Pathway have led to improvements in Standards 1 and 2. The addition of an orthogeriatric service in the hospital has resulted in an improvement in adherence to all IFHD standards. However, there are ongoing challenges to achieving Standard 2 including limited theatre access and increasing numbers of older patients on novel oral anticoagulants.

scholarly journals 245 Delirium Incidence in Hip Fracture Patients: Awareness on the Orthopaedic Ward

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Rebecca Jeanne Bermingham ◽  
Paul McLaughlin ◽  
Helen O'Brien
Keyword(s):  
Hip Fracture ◽  
Health Professionals ◽  
Postoperative Delirium ◽  
Allied Health ◽  
Surgical Complication ◽  
Management Plan ◽  
Allied Health Professionals ◽  
Orthopaedic Surgeons ◽  
Number Of Patients ◽  
Increased Risk

Abstract Background Postoperative delirium is a serious neuropsychiatric condition that occurs in up to 65% of hip fracture patients(1). However, it remains poorly recognised as a postoperative surgical complication despite its association with increased mortality, longer length of stay (LOS), cognitive decline and increased risk of discharge institutionalisation. Methods As part of the delirium audit, all hip fracture patient notes were reviewed from Oct-Nov 2017 pre-implementation of an Orthogeriatric Service and Oct-Nov 2018 post-implementation. Documentation of delirium or use of the terms ‘new confusion, altered attention, change in behaviour’ in the orthopaedic, orthogeriatric and allied health professional notes were reviewed. The 4AT was used to routinely screen for delirium in the pre-and post-operative period by the Orthogeriatrics team(2). Results The number of patients in the 2017 group was 24, mean age 78, female 76% compared with 25 in the 2018 group, mean age 75.9, female 81%. In 2017, delirium was diagnosed in 4% of patients by the Orthopaedic surgeons and 37.5% by Allied Health Professionals. In 2018 delirium was diagnosed in 4% by the Orthopaedic surgeons, 40% by Allied Health Professionals and 44% by the Orthogeriatrics team in 2018. Pre-operative delirium occurred in 16% of patients and postoperative delirium occurred in 44% of patients in 2018. A clear delirium management plan was documented in 0% of charts in 2017 versus 100% in 2018. LOS in 2017 was 12.7 days vs 12.4 in 2018. However, discharge location varied greatly with 33.3% discharged to convalescence in 2017 versus 19% in 2018, 12.5% to Longterm care in 2017 versus 4% in 2018, 20.8% to rehabilitation in 2017 vs 52% in 2018 and 16.7% home in 2017 vs 24% in 2018. Conclusion Prompt diagnosis and management of delirium is essential in optimising postoperative cognitive function and preserving independence. Our study highlights the need for routine delirium screening and improved awareness of delirium amongst all healthcare professionals.

scholarly journals 148 Orthogeriatrics, Just the Beginning

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Hannah Smyth ◽  
Siofra Hearne ◽  
Pheadra Monahan ◽  
Rebecca Bermingham ◽  
Sidra Nawab ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Health Assessment ◽  
Group Versus ◽  
Fragility Fractures ◽  
Working Hours ◽  
Significant Loss ◽  
National Average ◽  
Service Group ◽  
Orthopaedic Ward ◽  
Service Introduction

Abstract Background The most common cause of admission to the orthopaedic ward are low trauma falls resulting in a hip fracture. These fragility fractures occur in older, frail, multi-morbid patients and they are associated with a high mortality rate and significant loss of independence. The Irish Hip Fracture Database is a national clinical audit that aims to improve hip fracture care and patient outcomes. Using the Irish Hip Fracture Standards, we aimed to audit the care of hip fracture patients in an Irish Model 3 Hospital pre- and post- implementation of an orthogeriatrics service. Methods Local Irish Hip Fracture Database was reviewed to assess the six Irish Hip Fracture Standards prior and 4 months following the introduction of a consultant-led dedicated orthogeriatrics service. Results There were 63 hip fracture patients (mean age 81) in the pre-service group and 69 (mean age 81) in the post-service group. Standard 1: 3.2% of hip fractures were admitted to the orthopaedic ward within 4 hours in the pre-service group versus 18.8% post-service introduction (national average 11%, 2017). Standard 2: 67.9% underwent surgery within 48 hours and during working hours versus 67.8% (national average 69%, 2017). Standard 3: 3.5% developed a pressure ulcer during their stay pre-service versus 1.6% post-service (national average 3%, 2017). Standard 4: 4.8% were assessed by a Geriatrician pre-service versus 84% post-service (national average 50%, 2017). Standard 5: 24.6% received a bone health assessment versus 87.5% post-service (national average 73%, 2017). Standard 6: 1.8% received a falls assessment prior to discharge versus 82.8% post-service (national average 47%, 2017). Conclusion The introduction of a dedicated orthogeriatrics service has led to a more collaborative multi-disciplinary approach to patient care with evidence of improvements in all Irish Hip Fracture Standards. Commitment to a resourced orthogeriatric service providing rapid comprehensive geriatric assessments is essential to advance improvements in older patients’ care.

Triage and resource allocation during crisis medical surge conditions (pandemics and mass casualty situations)

2020 ◽  
Vol 7 (1) ◽  
pp. 45-55
Author(s):  
Paul Hoehner ◽  
David H. Beyda ◽  
William P. Cheshire ◽  
Robert E. Cranston ◽  
John T. Dunlop ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Medical Association ◽  
Health Professionals ◽  
Task Force ◽  
Position Statement ◽  
Mass Casualty ◽  
Medical Conditions ◽  
Direct Response ◽  
Allied Health Professionals ◽  
A Current

The Christian Medical and Dental Associations (CMDA) was founded in 1931 and is made up of the Christian Medical Association (CMA) and the Christian Dental Association (CDA). CMDA has a current membership of over 19,000 physicians, dentists, and other allied health professionals. During and in direct response to the pressing urgencies of the COVID-19 universal pandemic of 2020 the President of CMDA commissioned a special task force to provide current and future Christian reflection and guidance on triage and resource allocation policies during pandemics and other forms of crisis surge medical conditions (e.g., mass casualty situations). This is a condensed version of the CMDA special task force position statement. 

scholarly journals B-AB05-03 A SAME DAY DISCHARGE STRATEGY AFTER ATRIAL FIBRILLATION ABLATION THAT IS OVERSEEN BY ALLIED HEALTH PROFESSIONALS CAN BE INITIATED SAFELY AND EFFECTIVELY

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S8
Author(s):  
Lauren Ashley Rousseau ◽  
Nicole M. Bourque ◽  
Tiffany Andrade ◽  
Megan E.B. Antonellis ◽  
Patrice Hoskins ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Health Professionals ◽  
Allied Health ◽  
Atrial Fibrillation Ablation ◽  
Allied Health Professionals ◽  
Same Day Discharge

scholarly journals Sustainable healthcare – Time for ‘Green Podiatry’

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Angela Margaret Evans
Keyword(s):  
Climate Change ◽  
Carbon Dioxide ◽  
Greenhouse Gases ◽  
Health Professionals ◽  
Carbon Dioxide Emissions ◽  
Allied Health ◽  
World Health ◽  
Main Body ◽  
Allied Health Professionals ◽  
Foot Health

Abstract Background Healthcare aims to promote good health and yet demonstrably contributes to climate change, which is purported to be ‘the biggest global health threat of the 21st century’. This is happening now, with healthcare as an industry representing 4.4% of global carbon dioxide emissions. Main body Climate change promotes health deficits from many angles; however, primarily it is the use of fossil fuels which increases atmospheric carbon dioxide (also nitrous oxide, and methane). These greenhouse gases prevent the earth from cooling, resulting in the higher temperatures and rising sea levels, which then cause ‘wild weather’ patterns, including floods, storms, and droughts. Particular vulnerability is afforded to those already health compromised (older people, pregnant women, children, wider health co-morbidities) as well as populations closer to equatorial zones, which encompasses many low-and-middle-income-countries. The paradox here, is that poorer nations by spending less on healthcare, have lower carbon emissions from health-related activity, and yet will suffer most from global warming effects, with scant resources to off-set the increasing health care needs. Global recognition has forged the Paris agreement, the United Nations sustainable developments goals, and the World Health Organisation climate change action plan. It is agreed that most healthcare impact comes from consumption of energy and resources, and the production of greenhouse gases into the environment. Many professional associations of medicine and allied health professionals are advocating for their members to lead on environmental sustainability; the Australian Podiatry Association is incorporating climate change into its strategic direction. Conclusion Podiatrists, as allied health professionals, have wide community engagement, and hence, can model positive environmental practices, which may be effective in changing wider community behaviours, as occurred last century when doctors stopped smoking. As foot health consumers, our patients are increasingly likely to expect more sustainable practices and products, including ‘green footwear’ options. Green Podiatry, as a part of sustainable healthcare, directs us to be responsible energy and product consumers, and reduce our workplace emissions.

scholarly journals COVID-19: Nutrition and functional outcomes for critical care survivors in a 400- bedded district general hospital in North London

2021 ◽  
pp. 175114372110254
Author(s):  
Rachel Catlow ◽  
Charlotte Cheeseman ◽  
Helen Newman
Keyword(s):  
Critical Care ◽  
General Hospital ◽  
Health Professionals ◽  
Functional Outcomes ◽  
Critical Care Unit ◽  
Workforce Planning ◽  
District General Hospital ◽  
Allied Health Professionals ◽  
Novel Coronavirus ◽  
Rehabilitation Needs

Novel coronavirus disease (COVID-19) has resulted in huge numbers of critically ill patients. This study describes the inpatient recovery and rehabilitation needs of patients admitted with COVID-19 to the critical care unit of a 400 bedded general hospital in London, United Kingdom. The rehabilitation needs of our sample were considerable. It is recommended that the increase demand on allied health professionals capacity demonstrated is considered in future COVID-19-related workforce-planning.

scholarly journals Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic

2021 ◽  
Vol 12 ◽  
pp. 215145932110066
Author(s):  
Naoko Onizuka ◽  
Lauren N. Topor ◽  
Lisa K. Schroder ◽  
Julie A. Switzer
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Healthcare System ◽  
Perioperative Complications ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Surgical Care ◽  
Admission Rate ◽  
System Response ◽  
Fragility Hip Fracture

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

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