Application of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric hip fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Chaoqun , CHANG Yunhe , ZHENG Yang , WANG Zhiqian , LI Yujia , YANG Yajing ,  WANG Qingxian

Department of Geriatric Orthopedics, Traumatic Emergency Center, the Third Hospital of Hebei Medical University, Hebei Provincial Biomechancial Key Laboratory, Hebei Provincial Othopedic Institute, Shijiazhuang Hebei, 050051, P.R.China;

Corresponding author：

WANG Qingxian, Email: wqxwx1028@163.com

Keywords：

Multidisciplinary team; doctor-nurse collaboration; geriatric hip fracture; perioperative period

DOI：

10.7507/1002-1892.201805068

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Objective To investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.Methods The clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.Results The surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ²=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).Conclusion Multidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.

Citation： WANG Chaoqun, CHANG Yunhe, ZHENG Yang, WANG Zhiqian, LI Yujia, YANG Yajing, WANG Qingxian. Application of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric hip fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1283-1286. doi: 10.7507/1002-1892.201805068 Copy

1.	刘粤, 郝玮, 张岩, 等. 多学科协作综合治疗老年髋部骨折的疗效. 中国老年学杂志, 2014, 34(19): 5481-5484.
2.	王国旗, 龙安华, 张立海, 等. 老年髋部骨折合并糖尿病患者围手术期血糖水平对预后的影响. 中国修复重建外科杂志, 2014, 28(7): 844-847.
3.	王艳, 吴新, 汤根芬. 家庭访视护理干预对老年髋部骨折术后病人生活质量的影响. 齐齐哈尔医学院学报, 2012, 33(13): 1803-1805.
4.	方秀统, 张新, 王博, 等. 老年人髋部骨折术后死亡分析. 骨与关节损伤杂志, 2004, 19(7): 442-444.
5.	陈佳, 李西成. 髋部骨折: 争议与挑战. 中华老年骨科与康复电子杂志, 2017, 3(4): 193-196.
6.	贾学宽, 孙天胜. 血液指标对老年髋部骨折死亡率预测研究进展. 实用骨科杂志, 2015, 21(12): 1093-1095.
7.	Grass C, Umansky R. Problems in promoting the growth of multi-disciplinary diagnostic and counseling clinics for mentally retarded children in nonmetropolitan areas. Am J Public Health, 1971, 61(4): 698-710.
8.	Whitehouse M. A policy framework for commissioning cancer services. BMJ, 1995, 310(6992): 1425-1426.
9.	Althausen PL, Shannon S, Owens B, et al. Impact of hospital-employed physician assistants on a level Ⅱ community-based orthopaedic trauma system. J Orthop Trauma, 2016, 30(Spuppl 5): S40-S44.
10.	Soong C, Cram P, Chezar K, et al. Impact of an integrated hip fracture inpatient program on length of stay and costs. J Orthop Trauma, 2016, 30(12): 647-652.
11.	Christmas AB, Reynolds J, Hodges S, et al. Physician extenders impact trauma systems. J Trauma, 2005, 58(5): 917-920.
12.	Spisso J, O’Callaghan C, McKennan M, et al. Improved quality of care and reduction of housestaff workload using trauma nurse practitioners. J Trauma, 1990, 30(6): 660-663.
13.	Jarrett LA, Emmett M. Utilizing trauma nurse practitioners to decrease length of stay. J Trauma Nurs, 2009, 16(2): 68-72.
14.	Haan JM, Dutton RP, Willis M, et al. Discharge rounds in the 80-hour workweek: importance of the trauma nurse practitioner. J Trauma, 2007, 63(2): 339-343.
15.	Friedman SM, Mendelson DA, Bingham KW, et al. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med, 2009, 169(18): 1712-1717.
16.	Della Rocca GJ, Moylan KC, Crist BD, et al. Comanagement of geriatric patients with hip fractures: a retrospective, controlled, cohort study. Geriatr Orthop Surg Rehabil, 2013, 4(1): 10-15.
17.	Prestmo A, Hagen G, Sletvold O, et al. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet, 2015, 385(9978): 1623-1633.
18.	Nyberg SM, Keuter KR, Berg GM, et al. Acceptance of physician assistants and nurse practitioners in trauma centers. JAAPA, 2010, 23(1): 35-41.
19.	徐江波, 袁宏, 赵喜滨, 等. 520 例老年骨科患者围手术期风险因素相关性分析. 新疆医科大学学报, 2008, 31(10): 1382-1384.
20.	张静梅, 张立涛, 梁俊生. 老年骨科患者并存内科系统疾病调查分析. 中国骨质疏松杂志, 2012, 18(4): 336-338.
21.	宋婷婷, 王新民, 毕希乐, 等. 老年髋部骨折围术期心力衰竭的危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(1): 23-28.
22.	谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.

1. 刘粤, 郝玮, 张岩, 等. 多学科协作综合治疗老年髋部骨折的疗效. 中国老年学杂志, 2014, 34(19): 5481-5484.
2. 王国旗, 龙安华, 张立海, 等. 老年髋部骨折合并糖尿病患者围手术期血糖水平对预后的影响. 中国修复重建外科杂志, 2014, 28(7): 844-847.
3. 王艳, 吴新, 汤根芬. 家庭访视护理干预对老年髋部骨折术后病人生活质量的影响. 齐齐哈尔医学院学报, 2012, 33(13): 1803-1805.
4. 方秀统, 张新, 王博, 等. 老年人髋部骨折术后死亡分析. 骨与关节损伤杂志, 2004, 19(7): 442-444.
5. 陈佳, 李西成. 髋部骨折: 争议与挑战. 中华老年骨科与康复电子杂志, 2017, 3(4): 193-196.
6. 贾学宽, 孙天胜. 血液指标对老年髋部骨折死亡率预测研究进展. 实用骨科杂志, 2015, 21(12): 1093-1095.
7. Grass C, Umansky R. Problems in promoting the growth of multi-disciplinary diagnostic and counseling clinics for mentally retarded children in nonmetropolitan areas. Am J Public Health, 1971, 61(4): 698-710.
8. Whitehouse M. A policy framework for commissioning cancer services. BMJ, 1995, 310(6992): 1425-1426.
9. Althausen PL, Shannon S, Owens B, et al. Impact of hospital-employed physician assistants on a level Ⅱ community-based orthopaedic trauma system. J Orthop Trauma, 2016, 30(Spuppl 5): S40-S44.
10. Soong C, Cram P, Chezar K, et al. Impact of an integrated hip fracture inpatient program on length of stay and costs. J Orthop Trauma, 2016, 30(12): 647-652.
11. Christmas AB, Reynolds J, Hodges S, et al. Physician extenders impact trauma systems. J Trauma, 2005, 58(5): 917-920.
12. Spisso J, O’Callaghan C, McKennan M, et al. Improved quality of care and reduction of housestaff workload using trauma nurse practitioners. J Trauma, 1990, 30(6): 660-663.
13. Jarrett LA, Emmett M. Utilizing trauma nurse practitioners to decrease length of stay. J Trauma Nurs, 2009, 16(2): 68-72.
14. Haan JM, Dutton RP, Willis M, et al. Discharge rounds in the 80-hour workweek: importance of the trauma nurse practitioner. J Trauma, 2007, 63(2): 339-343.
15. Friedman SM, Mendelson DA, Bingham KW, et al. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med, 2009, 169(18): 1712-1717.
16. Della Rocca GJ, Moylan KC, Crist BD, et al. Comanagement of geriatric patients with hip fractures: a retrospective, controlled, cohort study. Geriatr Orthop Surg Rehabil, 2013, 4(1): 10-15.
17. Prestmo A, Hagen G, Sletvold O, et al. Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet, 2015, 385(9978): 1623-1633.
18. Nyberg SM, Keuter KR, Berg GM, et al. Acceptance of physician assistants and nurse practitioners in trauma centers. JAAPA, 2010, 23(1): 35-41.
19. 徐江波, 袁宏, 赵喜滨, 等. 520 例老年骨科患者围手术期风险因素相关性分析. 新疆医科大学学报, 2008, 31(10): 1382-1384.
20. 张静梅, 张立涛, 梁俊生. 老年骨科患者并存内科系统疾病调查分析. 中国骨质疏松杂志, 2012, 18(4): 336-338.
21. 宋婷婷, 王新民, 毕希乐, 等. 老年髋部骨折围术期心力衰竭的危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(1): 23-28.
22. 谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.

Chinese Journal of Reparative and Reconstructive Surgery

Application of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric hip fractures

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