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Solution Title: An Orthopaedics Approach to Population Health Management –

Development of a Geriatric Hip Fracture Program (GHF)

What was the problem to be solved? How was it identified? What baseline data existed?

What were the goals—how would you know if you were successful?

In today’s healthcare environment, organizations are continuously challenged to meet the

Institute for Healthcare Improvement’s Triple Aim, a cornerstone of the revised Global Budget

Revenue (GBR) model. The GBR model emphasizes better care, better health and lower costs for

all Maryland patients[1]. Until recently, no formalized program had been developed to address a

small but impactful patient population seen in our emergency departments. In focusing on

optimizing care for a vulnerable patient population, The University of Maryland Upper

Chesapeake Health has recently taken many significant steps in this journey to achieve the goals

of the Triple Aim.

As the population in Maryland continues to age, the number of acute hip fractures presenting to

our emergency department will likely continue to increase. To achieve the goals set forth by the

Triple Aim, health systems will need to continue to expand their focus on high-risk patient

populations that can have an impact on future healthcare resources. A hip fracture in an elderly

person is not just a broken bone; it can be a life altering medical condition. It is estimated that

only 50% of hip fracture patients return to their baseline activity level prior to the injury and

even more staggering is that elderly adults who suffer a hip fracture are 5 times more likely to be

placed in a nursing home for continuous care. Most alarming, according to a study published by

JAMA in 2013, the estimated 1-year all-cause mortality rate for an elderly hip fracture patient

was 24% [2].

There is a growing trend among health systems to address this vulnerable patient population by

developing a coordinated Geriatric Hip Fracture (GHF) program focused on improving outcomes

by implementing evidence based clinical practice guidelines. The development of a program

focuses on expedited surgical intervention, early mobilization, and standardized clinical care

pathways following surgery, all factors proven to drastically influence both a patient’s clinical

outcomes as well as quality of life following a traumatic hip fracture.

UM Upper Chesapeake Health sees an average of 220 acute hip fractures each year and nearly

90% require surgical intervention. Knowing that early intervention is key to improving patient

outcomes, the UM UCH Department of Orthopaedics wanted to evaluate our current

performance with caring for this population to determine if a coordinated Geriatric Hip Fracture

program was needed. UM UCH engaged DePuy Synthes Advantage, a program consulting

division within Johnson & Johnson, to help evaluate the need for developing a program, DePuy

Program/Project Description, including Goals

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Synthes provided four key indicators that are directly associated with improved patient outcomes

for acute hip fracture patients:

1. Average Admission to Surgery

2. Average Length of Stay

3. 30 Day All-Cause Readmission Rate

4. One Year All-Cause Mortality Rate

UM UCH examined all acute hip fractures

treated at either UM UCMC or UM HMH

between July 2014 and June 2015 (Fiscal

Year 2015). In that period, UM UCH treated

212 acute hip fractures and outlined in Table

1 are the UCH metrics compared to

benchmarks provided by DePuy Synthes to

measure the performance of coordinated

Geriatric Hip Fracture programs. Based on

the comparative date outlined in Table 1, the

UM UCH Department of Orthopaedics was able to demonstrate to UM UCH Leadership the valve

of developing a coordinated Geriatric Hip Fracture Program with a focus on expedited care to

achieve improvements in the following key areas:

1. Decrease in Average Admission to Surgical Intervention

2. Decrease in Average Length of Stay

3. Decrease in 30 Day All Cause Readmissions

4. Decrease 1 Year All-Cause Mortality Rate to 16%

These indicators are commonly used in the evaluation of a program related to hip fractures with

the ultimate goal for any hip fracture program being - #4 Decrease One-Year All-Cause

Mortality. Because hip fractures typically occur in elderly adults with multiple medical co-

morbidities, a hip fracture can be the catalyst event that ultimately leads to a downward spiral in

that patients overall health. The ultimate goal associated with developing a program focused on

this patient population would be to utilize evidence based best practice, to extend independence

and a return patient to their previous function, ultimately decreasing mortality and morbidity in

this predominately elderly and more fragile population.

What methodology or process was used to develop the solution? What Solution was

developed? How was it implemented?

IMPRV (Identify, Measure, Process, Re-Think and Validate) is a best-in-class methodology

founded upon the key tenets of Lean, Six Sigma, project management, and change management

theories. IMPRV provides a structured way for UM UCH teams to identify opportunities for

improvement, analyze the situation, and develop a solution to solve the problem at hand.

Table 1: Outcome Metrics UCH compared to

GHF Program Benchmarks

2015

UM UCH

GHF

Benchmarks

Admission to Surgery 32h 52m 24h 00m

Average Length of Stay 5.3 4.0

Readmission Rate 12.5% 8.0%

1 Year Mortality 24% 16%

Process & Solution

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In late 2016, UM UCH engaged an outside consultant (DePuy Synthes Advantage) to assist in

the management / development of the Geriatric Hip Fracture Program (GHF). UM UCH choose

to utilize an outside consultant in this project because DePuy Synthes Advantage had

successfully collaborated with over 150 health systems throughout the U.S. to implement GHF

programs. In addition, DePuy Synthes had access to the latest in evidence based clinical

pathways, standardized order sets, patient and family education materials and data / metric

tracking solutions. One of the most critical aspects of the program was to hire a dedicated

Fragility Fracture Coordinator to lead the program develop and also act as a patient navigator

once the program was implemented. Led by a Fragility Fracture Coordinator and three physician

sponsors (2 Orthopaedic Surgeons & 1 Geriatrician), the team applied the IMPRV Methodology

to meet their goal as detailed below.

Identify: The key objective of the Identify Phase is to clearly define the problem, identify the

current state, and develop a solid business justification for executive and organizational

sponsorship. The multidisciplinary team consisting of members from Orthopedic Surgery,

Nursing Leadership, Medical Staff Leadership, Quality, Geriatric Medicine, IT, Anesthesia,

Perioperative Services, Case Management, and Physical Therapy assembled to outline the

opportunity for improvement, scope, and goals of the project. Once the team felt they had a keen

understanding of the problem to be solved, they moved on to the Measure Phase. Opportunities

for improvement identified were as follows:

Standardized “geriatric friendly” order sets, care plans

Standardize admitting service criteria upon ED arrival

Standardized patient assessment guidelines/processes

Geriatric pain management standardization

Anti-coagulation reversal guidelines

Operative suite availability

Urgency of intervention

Delirium diagnosis and treatment

Co-ownership of patient throughout process

Patient aggregation

Osteoporosis assessment and management

Setting expectations and communication of plan of care

Measure: In the Measure Phase the team worked to further understand the current state of the

process and collect sound data on process performance. All key stakeholders were asked to

complete a current state survey outlining how each discipline cared for hip fracture patients at

UM UCH. The workflow was evaluated, stakeholder surveys were conducted, and the following

data was collected:

Ed arrival to admission (average in hours)

Admission to surgery (average in hours)

Length of stay (average in days)

Mortality rate (in house)

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% cases complicated by pneumonia

% cases with drug induced delirium

% cases with UTI not present on admission

% cases with hospital acquired injury not present on admission

% cases with decubitus ulcer not present on admission

% cases with DVT/ PE

% cases readmitted in 30 days (all cause)

% cases with post-discharge ED utilization (all cause)

Average cost per case

Current State Process:

Survey Results:

Lack of Pre-Operative communication

Need for ED Order Set

Need for better Staff Communication

Need shared patient ownership or hospitalist should own PT

Patient and Family communication should start earlier

Patient urgency to OR is not standard and very fluctuating

Standardization of practice inconsistent

Need for more established care/coordination

Need for weight baring standardization

Admission order sets are in place, but not being used

Baseline Data:

Figure 1: UM UCH FY 2015 Process and Demographic Indicators

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Figure 2: UM UCH FY 2015 Quality of Care 7 Patient Safety Indicators, Discharge Destination, and Financial/

Efficiency Indicators

Process: During the Process Phase, the team used the process and performance information from

the Measure Phase to assess and analyze process data, perform root cause analysis for potential

issues, and identify waste and inefficiency. The team recognized multiple opportunities for

improvement. The existing Geriatric Fracture Program was divided into several phases with the

average amount of time a patient spent in each of those phases also included from observations

and data analysis. The purpose of breaking down the overall process into different phases was to

help identify potential areas of focus for improvement. Within each phase of the process, there

were several opportunities and root causes identified:

ED – Floor

o Standardize the admission process (attending, orders, pathway)

o Early diagnosis & treatment

o Patient & family education on hip fractures

Floor – Surgery

o Establish medical ownership of patient

o Expedite medical clearance

o Establish cardiac evaluation / management recommendation

Surgery – Discharge o Inconsistent medical / surgical ownership of post-operative care

o Delirium awareness / education

o Geriatric friendly order sets / clinical pathways

o Lack of patient navigation

o Inconsistent case management / discharge planning

o Gaps in communication with family / patient / providers

o Patient & family education

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In addition to opportunities present in each phase of the process, there was an overall gap in

coordinating care identified through observations and surveys. Improving the coordination of

care was a key guiding principle as the team moved to the Re-think phase.

Re-Think: The main objective of Re-Think is to design a safer and more efficient process.

During this phase we outlined a full-scale implementation plan of our improvement solutions.

Outlined below is a GHF Patient Flow Goal outlined during Re-Think to highlight solutions and

the overall impact on a patient’s length of stay:

Our solutions are as follows:

Solution 1: Hire Fragility Fracture Coordinator

When UM UCH received approval to move forward with the development of a GHF Program, it

was evident that we needed a dedicated coordinator to manage the program and act as a patient

care navigator. UM UCH has been successful in other clinical service line programs (joint,

spine, bariatric and stroke), with hiring a coordinator / program manager to implement, monitor

and sustain all aspects of the clinical program. Prior to implementing the IMPRV process, UM

UCH leadership approved the recruitment of a clinical professional with experience in patient

navigation, case management, program development and orthopaedics. In the fall of 2016, UM

UCH hired Rosemarie Palmere, RN as the Fragility Fracture Coordinator.

Solution 2: Standardized Hip FX Order Set and Clinical Pathway (Emergency Dept,

Admission and Post-Op)

The initial step in the patient process was focused on updating the Emergency Department

orders. The current orders were vague and did not clearly delineate the steps to diagnose and

prepare a patient for medical evaluation. This led to delays in treatment and inconsistency as to

what was done prior to admission. The following solutions were identified to address these

issues:

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Possible signs/identifiers were developed to assist the ER nurses in identifying a probable

hip fracture, allowing for early x-ray to confirm. Once the hip fracture is confirmed,

orders were set in place to begin the pre-op clearance process in the Emergency

Department; orders included lab work, EKG, Foley catheter placement and chest x-ray.

The Hip Fracture Admission Order Set was developed with an interdisciplinary

partnership between medicine, orthopaedic surgery, anesthesiology, cardiology and

nursing. The goal was to use medications that would treat pain without creating delirium.

Fragility labs were included to identify osteoporosis markers for post-op follow up care.

Using best practice, a new policy was established to identify which patients needed

cardiac clearance prior to surgery in an effort to decrease unnecessary delays resulting

from awaiting clearance. Proper identification of the appropriate attending group allowed

for medicine to manage the majority of hip fractures, further expediting clearance and

streamlining the preoperative care for hip fractures. In addition, a new order for intra-

operative block placement for pain management was added to facilitate multimodal pain

management protocols and oral tranexamic acid was added to decrease intra-operative

bleeding.

Finally the Hip Fracture Post-Op orders were designed to decrease delirium and allow for

timely discharge to the appropriate post-acute setting. The nursing department completed

mandatory delirium training to differentiate between delirium and dementia. Timely

identification of delirium allows for early intervention. A CAM assessment was added to

the orders as a nursing intervention to be completed every shift. All medications were

reviewed by a Gerontologist trained hospitalists for avoidance of known delirium causing

agents. Orders were created to monitor for urinary retention, to further aid in avoiding

delirium. And the orthopedic surgeons used a risk stratification protocol to choose

appropriate anticoagulation with the goal of not placing the patient in risk of developing

an unwanted postoperative hematoma. And during our monthly Steering Committee

Meetings, we identified additional areas of focus on delays in discharge for this

population secondary to constipation so medications to facilitate bowel movements was

added to prevent delay.

Solution 3: Develop Navigation Support Model

The nurse navigator role was developed to assist in program development and facilitation of

protocol roll out. The navigator is the primary point of contact for the patient and family during

and after the hospital stay. Their primary responsibilities include conducting initial patient

assessments, patient and family education, daily rounding, facilitating communication between

the nursing team and providers, discharge planning, and follow up care coordination. Patients

receive follow up phone calls 30 days and 90 days after their procedure to ensure post-operative

care and osteoporosis follow-up are being completed.

Solution 4: Delirium Assessment Protocol and Order Set

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Nurse education and shift evaluation for delirium is essential for early identification and

treatment of delirium. Conducting nursing assessments for urinary retention with bladder scan

can expedite the removal of Foley catheters. IVF orders provide nursing with guidance to follow

I&O’s and communicate with medical service for prevention of dehydration and inability to

void. The nurse educators developed a Delirium Education Module which defines delirium,

identifies symptoms, and explains why recognizing and caring for delirium patients is essential.

Education on differentiating delirium verses dementia is mandatory for the orthopedic nurse.

Solution 5: Patient/ Family/ Staff Education Materials

Early patient and family education is important aspects of care for elderly patients suffering from

a hip fracture. Since hip fractures can exacerbate other medical conditions in elderly patients,

providing information to patients and family on the benefits of early intervention, mobilization,

activity and rehabilitation are critical to ensuring patients return to their pre-injury baseline.

Patient education is done through one on one discussion, written handouts and follow-up phone

calls. Patients are given written material as early as in the ED to explain hip fracture and

discharge needs and planning. Patients are then visited in the hospital by the nurse navigator and

receive a phone call for osteoporosis follow up. In addition, the clinical team caring for this

patient population is provided the education through monthly departmental staff meetings and at

first monthly, now quarterly interdisciplinary meetings.

Solution 6: Development of Co-Management Model / Admission Criteria

Co-Management was a crucial process for identification of the appropriate provider and

resources for the hip fracture patient. By spelling out specific criteria for admission to the

hospitalist service verses the orthopaedic surgical service. This structure allowed for only low

risk patients to be admitted to the orthopedic service, permitting the hospitalist service to take

patients with significant co-morbidities who would require closer monitoring and management.

The Co-Management Model requires the development of a document that outlines admission

criteria and clear delineation of responsibilities for each service. The agreement is then officially

approved and presented to each department and the clinical team. The delineation allowed for

earlier clearance and better medical management. In addition, the Co-Management model

provided the clinical team with clear guidelines on which service (orthopaedics or medicine) to

contact to resolve any acute concerns. This gives nursing a clear pathway to follow for expedited

and accurate follow-up in the post-operative period. Based on the delineated responsibilities we

saw a reduction in length of stay and readmissions with the implementation of the program.

There was a noted improvement in outcomes for the hip fracture patients and communication

between the clinical team.

Solution 7: Development of Perioperative Cardiac Evaluation and Management Policy

Restructuring the current pre-operative clearance enabled more efficient use of physician time,

and resulted in appropriate referrals. The new policy was evidence based best practice as

recommended by the American College of Cardiology, and the American Heart Association and

was developed in conjunction with Cardiology, Anesthesia and Internal Medicine. Through

streamlining the process, we saw a decrease in delay of surgery and a decrease in unnecessary

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cardiac testing. Improved physician productivity and efficiency was also noted. By developing a

hospital policy, the physicians felt reassured they had hospital support to follow evidence based

guidelines for cardiac evaluation and management. This helped to redirect efforts towards

patients that truly needed cardiac consultation prior to surgery.

Solution 8: Incorporation of GHF Team in Interdisciplinary Rounds

Use of interdisciplinary rounds was instituted at UM UCH a year ago to improve communication

and care coordination. This new model of care provided a platform that allowed the GHF team

be interactive on a daily bases with the clinical team caring for hip fracture patients. Improved

communication and decreased errors is essential when more than one discipline cares for a

patient and one of the primary components of the GHF program was care coordination for this

population. Improved outcomes and decreased readmissions were a direct result of good team

work and clear lines of communication. The incorporation of the GHF team into the rounding

process provided the framework for adherence to the clinical pathway.

Validate: The key objective of the final phase of IMPRV is to complete solution

implementation, ensure process accuracy, and provide comprehensive training on the solutions to

ensure sustainment.

What are the results of implementing the Solution? Provide qualitative and/or quantitative

results to data. (Please include graphs, charts, or tools.)

In April 2017, UM UCH officially launched the Geriatric Hip Fracture Program at UM Upper

Chesapeake Medical Center and UM Harford Memorial Hospital. Initially the program was

successful by increasing the collaboration between orthopaedic surgeons and internal medicine

providers in caring for hip fracture patients. Additionally, the program heightened the sense of

urgency with the clinical team to expedite clearance and surgical intervention, a critical success

factor in improving outcomes for hip fractures.

The program also helped improve the care coordination between the hospital and post-acute care

facilities. The Fragility Fracture Coordinator met with the Director of Nursing’s for each local

skilled nursing facility to overview the program and expectations associated with caring for a

post-op hip fracture. And our ultimate goal is to expand this collaboration by evaluating what

services can be safely offered at a skilled nursing facility to decrease the acute hospital length of

stay.

The Geriatric Hip Fracture program also expanded the clinical teams awareness regarding the

impact delirium can have on an elderly post-operative hip fracture. Focusing on appropriate

medications and interventions to limit the risk of delirium have been helpful in combating

significant delays in recovery associated with delirium. UM UCH is currently working on

expanding the delirium screening process for all patients within the health system, highlighting

the importance of screening and early intervention.

Measurable Outcomes

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The program also provided our team with an opportunity to engage patients and families in post-

injury follow-up to ensure the underlying cause of the injury was identified and treated. Most

hip fractures are a result of poor bone density and treating the underlying condition can have an

impact of future injury.

All of the above outlined benefits and solutions helped contribute to the initial impact of the

GHF program on key indicators that were outlined in the program justification. Outlined below

is a review of pre-program metrics compared with data collected from a newly created UM UCH

Hip Fracture Registry. The pre GHF metrics were based on outcome measures captured in Fiscal

Year 2016 and the post GHF program results were from April 2017 – September 2017 (6

months). As outlined in the original justification, key indicators for program success included

time intervals for ER – Admission, Admission – Surgery and Length of Stay. In addition the

program focused on the key quality outcomes of readmissions and one-year all-cause mortality

for this particular patient population. Since a component of the program is post discharge

follow-up, the program will be able to demonstrate the impact on mortality within 18 months.

Apr-Sept

ED Arrival - Admission (Hours) Pre GHF Post GHF

HMH 3.3 3.2

UCMC 4.6 4.0

4.0 3.7

Admission - Surgery (Hours) Pre GHF Post GHF

HMH 37.2 26.7

UCMC 28.6 23.0

32.9 24.0

Length of Stay Pre GHF Post GHF

HMH 5.4 5.4

UCMC 5.3 4.6

5.3 4.8

30 Day Readmission Rate Pre GHF Post GHF

HMH 11% 4%

UCMC 13% 6%

12% 5%

Co-Management 85% 95%

n=96

As a result of implementing the GHF program, UM UCH demonstrated an immediate decrease

in several key metrics. The impact was minimal on the ED-Admission average time (only 18

minutes), however, the revised order sets and the focus on early medical evaluation resulted in a

drastic decrease of almost 9 hours from the average admission to surgery metric, resulting in an

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average time from admission to surgery of 24.0 hours. As a result, UM UCH also observed a

significant impact on overall length of stay (0.5 day reduction) based on expedited surgical

intervention and implementing clinical best practices for recovery. And finally, the navigation

program had a significant impact on the 30 day readmission rate for this population, resulting in

a 41% decrease in just the first 6 months.

What measures are being taken to ensure that results can be sustained and spread?

The GHF program will be continuously monitored through a quarterly GHF Steering Committee

that is composed of key stakeholders caring for hip fractures patients and run by the Fragility

Fracture Coordinator. The results of program success will be monitored and reported to the

Patient Safety and Quality Council and the Medical Executive Committee to ensure all levels of

leadership are focused on the sustainability of the GHF program. UM UCH has also

implemented a GHF registry to track all patient both in the hospital and once discharged to

ensure navigation support continues to return patients to their pre-injury activity level. The GHF

team will continue to participate in Interdisciplinary rounds to ensure adherence to clinical

pathways and the GHF Steering committee will continue to evaluate extended lengths of stay or

opportunities to improve the GHF program to maintain patient outcomes outlined in the program

justification. The Fragility Fracture Coordinator will maintain program oversight of the GHF

program and shares the responsibility with two additional program coordinators within the

Clinical Service Line program at UM UCH. UM UCH has committed to improving the care

provided to patients and families suffering an acute hip fracture at UM UCMC and UM HMH

and the program structure outlined will ensure the program continues to improve and provide a

consistent and coordinated approach to hip fractures in our community.

What role did teamwork and collaboration play in the Solution? What partners and

participants were involved? Was the organization’s leadership engaged and did they share

the vision for success? How was leadership support demonstrated?

Teamwork was paramount to the success of this program. Due to the complexity of caring for

this patient population, the development of this program required collaboration between 5

physician specialties (anesthesia, emergency medicine, internal medicine, cardiology and

orthopaedics), spanning 2 acute hospitals and 12 hospital departments (emergency room,

operating room, acute nursing, rehabilitation, case management, and performance improvement).

The planning and implementation of this program included both front line and management staff

for each department, ensuring the program had buy-in and support from all levels.

Executive and physician leadership played a critical role in the development of the Geriatric Hip

Fracture program. Following the site survey, the consultant’s highlighted that UM UCH had

strong physician champions and leadership support to change the way we care for this

population. Our executive leadership team supported the program by allocating financial

resources (FTE, consulting fees, and conference support), performance improvement /

Sustainability

Role of Collaboration and Leadership

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administrative resident support and expedite committee approval). The physician support was

demonstrated through numerous planning meetings for order set development, co-management

planning, patient throughput meetings, education development and discharge planning. In

addition, two of the physician champions attended a conference on Co-Management of the

Elderly Hip Fracture that was funded by UM UCH and the knowledge gained during the

conference was used to develop appropriate order sets and clinical pathways to enhance the GHF

program.

What makes this Solution innovative? What are its unique attributes?

The GHF program included several new and innovative solutions that resulted in improved

outcomes. The first innovative solution was the development of a Co-Management Model with

Orthopaedics and the Hospitalist Service. For years, the two programs have debated on who is

the appropriate admitting service for patients with hip fractures and the current UM UCH

Admission policy was vague and open to interpretation. Developing a Co-Management model

allowed both specialties to identify criteria for admission to the appropriate service and since

implementation we have had complete adoption and eliminated the conflict between these two

specialties. In addition, the Co-Management model outlines which provider should be called for

specific concerns, i.e. the orthopaedics surgeons are responsible for post-op pain, rehabilitation

and wound management and the hospitalist are responsible for delirium, hypertension urinary

retention and glucose management. These clear lines of delineation have helped the clinical

team with directing phone calls and questions to the appropriate discipline and has drastically

decreased the unnecessary calls to both specialists.

The GHF program also expanded the use of Experal to hip fracture patients. Experal is a

liposomal bupivacaine injection that can provide regional pain control for up to 72 hours,

decreasing narcotic usage for patients that have a higher risk of delirium and are potentially

opioid naïve. In addition to expanding the use of Experal, the GHF program also adopted a

clinical best practice from the Joint Center program and initiated a risk stratification program for

VTE prophylaxis. Since the risk of post-operative bleeding is higher in this patient population,

low risk patients were placed on a full strength aspirin & sequential compression device (SCD)

protocol and moderate to high risk patients are prescribed a stronger anti-coagulation medication

to prevent DVTs.

What impact did the solution have on the culture of safety within the organization?

UM UCH recognizes the risks to the patients who have delays in surgery and the impact it can

have on outcomes. By expediting surgical intervention and providing a coordinated model of

care for hip fractures patients, we can directly impact the lives of our community. The most

significant figure outlined during the justification of this program was the one year all-cause

mortality rate (24%), based on our annual hip fractures volumes (220/year), that translated to 52

Innovation

Culture of Safety

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individuals within our community that pass away after suffering a hip fracture. Following the

implementation of a GHF program, other GHF programs have seen the mortality rate drop to

between 10-16%, impacting a potential 17-30 people within our community each year. That

factor alone was significant justification to both physician and executive leadership in allocating

the necessary resources to implement this program and change the culture within our

organization to improve care to a small but impactful population.

How did the solution include the patient and family?

Since hip fractures can have a significant impact not only on the patient’s life but also the family,

one of our key solutions involved developing a patient/family education handbook. A Hip

Fracture flyer is provided in the Emergency Department to any patient diagnosed with a hip

fracture, the flyer defines a hip fracture and explains surgery / recovery and prepares families to

start planning for discharge to a local sub-acute rehabilitation facility. In addition a Hip Fracture

Handbook was developed and provided to patients and family once they are admitted to the

nursing unit being prepared for surgery. The handbook outlines general information on what is a

hip fracture, how is it repaired, who is your care team, outlines recovery, what is osteoporosis

and sample exercises to strengthen muscles after surgery.

The development of the GHF program at UM UCH has been successful in increasing

communication and collaboration within the clinical team, resulting in an immediate impact on

key metrics of success. However the program is still developing and the impact on our

community is still yet to be seen but the UM UCH clinical and executive team are confident that

the implementation of the GHF Program will have an impact of countless families who will

continue to share memories with their elderly family members after they suffer from an acute hip

fracture. We truly believe that this program will have a drastic impact on our community and we

thank you for the opportunity to share our journey with you.

[1] The Triple Aim: Care, health, and cost. Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, health,

and cost. Health Affairs. 2008 May/June;27(3):759-769.

[2] Hung, W. W., Egol, K. A., Zuckerman, J. D., & Siu, A. L. (2012). Hip Fracture Management. JAMA, 307(20),

2185-2194.

Contacts

Nathaniel Albright, FACHE

AVP, Clinical Service Lines

Upper Chesapeake Health

443.643.3364

NAlbright@uchs.org

Tennile Ramsay

Patient Safety Officer

Upper Chesapeake Health

443-843-5634

tramsay@uchs.org

Related Tools and Resources

Patient and Family Integration

Conclusion