Older Chinese patients with fragility hip fracture in Hong Kong: calling for focused ortho-geriatric co-care

2019 ◽  
Vol 3 ◽  
pp. 19-19
Author(s):  
Hon-Ming Ma ◽  
Qi Ding ◽  
Louis Wing-Hoi Cheung ◽  
Simon Kwoon-Ho Chow ◽  
Kwok-Sui Leung
Keyword(s):  
Hong Kong ◽  
Hip Fracture ◽  
Chinese Patients ◽  
Fragility Hip Fracture ◽  
Older Chinese

scholarly journals A unified multidisciplinary fragility hip fracture pilot pathway in a trauma centre in Hong Kong: One-year outcome in the acute phase

2019 ◽  
Vol 26 (2) ◽  
pp. 77-84
Author(s):  
Matthew WH Lee ◽  
KH Chui ◽  
KK Tsang ◽  
KB Lee ◽  
Wilson Li
Keyword(s):  
Hong Kong ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Acute Phase ◽  
Performance Indicator ◽  
Surgical Complication ◽  
Trauma Centre ◽  
Unplanned Readmission ◽  
Complication Rates ◽  
Fragility Hip Fracture

Introduction: The growing impact of fragility hip fracture (FHF) on the healthcare system and the society has become a major concern worldwide. A unified multidisciplinary FHF pathway from admission to rehabilitation and back to community was established in 2015. The acute phase of the pathway was put into pilot in our hospital to evaluate the outcome. Method: A designated FHF team was established in our centre since January 2015. The FHF pathway was piloted since June 2015. Patients admitted with a hip fracture resulting from fall on standing height were included. Major outcome parameters were compared in three phases: (1) before FHF team and FHF pathway (January to December 2014), (2) after FHF team but before FHF pathway (January to May 2015) and (3) after FHF team and FHF pathway (June 2015 to May 2016). Result: In phases 1, 2 and 3, 631, 263 and 634 patients were included, respectively. From phases 1 to 3, the average key performance indicator (KPI) has improved from 49.2% to 65.8% to 70.0% significantly; average acute length of stay (days) has improved from 13.7 to 13.4 to 11.3 significantly; total surgical complication rates have improved from 6.2% to 7.6% to 5.8%. The 30-day mortality rate and the unplanned readmission rate (within 28 days) have remained below 2.7% and 2.2%, respectively. Conclusions: Implementation of an FHF pathway can form a multidisciplinary platform that can improve the standard of care and outcome for our FHF patients in terms of KPI and also length of stay. New knowledge added by this study: A newly designed and implemented fragility hip fracture pathway in our centre as a pilot with the results evaluated. Implications for clinical practice or policy: With the increasing elderly population in Hong Kong and globally, there is a need to design and implement a fragility hip fracture (FHF) pathway to improve the care and effectiveness for FHF patients.

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.

Patient participation

2010 ◽  
Vol 20 (2) ◽  
pp. 260-278 ◽  
Author(s):  
Wei Zhang
Keyword(s):  
Hong Kong ◽  
Pregnant Women ◽  
Genetic Counselling ◽  
Patient Participation ◽  
Qualitative Difference ◽  
Information Delivery ◽  
The Self ◽  
Chinese Patients ◽  
Chinese Group

This study analyses patient questions in prenatal genetic counselling (PGC) in a Hong Kong hospital. The focus is on the kinds of questions asked by the patients and the sequential environments in which the questions are asked. The ten patients in the study are pregnant women at or above 38 years of age, four local Cantonese-speaking Chinese, and six of Filipina or Thai origin. The PGC is conducted by a nurse who communicates with the Chinese patients in Cantonese and with the non-Chinese patients in English. Two broad types of questions, medical and administrative, in line with the purpose of PGC, are found in both groups. While both groups share a concern on the accuracy of the test, the Chinese group asks more questions on medical details beyond the issue of accuracy. With regard to sequential environments, questions may be either ‘occasioned’ by the nurse’s prior talk or ‘self-motivated’; both may occur in the positions for minimal responses in extended information delivery sequences. Self-motivated questions also occur as a second or later component in the patient’s extended turn. While the two groups of patients ask questions from either of the sequential positions, a qualitative difference lies in the turn design of the self-motivated questions.

scholarly journals Morbidity and mortality after fragility hip fracture in a Saudi Arabian population: Report from a single center

2017 ◽  
Vol 45 (3) ◽  
pp. 1175-1180 ◽  
Author(s):  
Mir Sadat-Ali ◽  
Moaad Alfaraidy ◽  
Abdulaziz AlHawas ◽  
Ahmed Abdallah Al-Othman ◽  
Dakheel A Al-Dakheel ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Mortality Rate ◽  
Demographic Data ◽  
Femoral Fractures ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Fragility Hip Fracture ◽  
Asa Score ◽  
Telephone Interviews ◽  
American Society

Objective To determine the functional morbidity and mortality after fragility hip fracture and compare the mortality with three other common diseases. Methods Data were collected from patients admitted to King Fahd Hospital of the University, AlKhobar from January 2010 to December 2014. Demographic data included the preoperative American Society of Anesthesiologists (ASA) score as assessed by the anesthetist and the type of surgery. Personal and telephone interviews were performed, and data were entered into a database and analyzed. Results We identified 203 patients with fragility proximal femoral fractures, and the data of 189 patients (109 male, 80 female; average age, 66.90 ± 13.43 years) were available for analysis. The overall mortality rate was 26.98% (51 patients). The mortality rate was significantly higher among patients with an ASA score of 4 (36.36%) than 1 (20.45%). With respect to morbidity, only 48.23% of patients were able to return to their pre-fracture status; 32.35% of those who required assisted walking and 83.4% of those who required a wheelchair became bedridden. Conclusions Our data demonstrate that patients with fragility hip fractures have high morbidity and a mortality rate approaching 30%. Age and the ASA score significantly influence this high mortality rate.

scholarly journals Influence of bone densitometry on the anti-osteoporosis treatment after fragility hip fracture

2018 ◽  
Vol 31 (10) ◽  
pp. 1525-1529 ◽  
Author(s):  
Peiwen Wang ◽  
Yizhong Li ◽  
Huafeng Zhuang ◽  
Haiming Yu ◽  
Siqing Cai ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Bone Densitometry ◽  
Osteoporosis Treatment ◽  
Fragility Hip Fracture
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