Standardized and detailed set of orders on
– Examining and imaging – Pain management – Fluid balance and nutritional care with supplements – Type of anesthesia (mainly spinal) – Surgical care for different fracture types – Delirium prevention and management – Oxygen therapy – Erythrocyte transfusion thresholds of hemoglobin – Urinary catheterization practices (removed on 1. postoperative day) – Mobilizing and physiotherapy – Deep venous thrombosis prophylaxis
Preround interview by a geriatric hip fracture nurse
– Living arrangements and the level of assistance needed before the fracture – Mobility level and walking aids before the fracture – Diagnosis of a memory disease or any concern of cognitive decline (prefracture Mini-Mental Status Examination score, if available) – Detailed information of circumstances of the fall – Mini-Nutritional Assessment, estimated height, weight and body mass index – Calcium intake (dietary and supplements) and vitamin D supplementation – Consent for data collection
Discharge Criteria
– Stable hemodynamics (oxygen saturation, pulse, and blood pressure, cardiac rhythm) – Hemoglobin > 90 g/L (>100 g/L if severe cardiac condition) – Urinary catheter removed – Pain under control – Patient mobilized – Medications updated to the outpatient file – If treated for infection, declining C-reactive protein (CRP) and fever – 2nd or later postoperative day – No discharge of a patient with immediate poor prognosis
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Interdisciplinary orthogeriatric ward rounds on weekdays
– Staff: geriatrician (or a resident), orthopedic hip fracture nurse, physiotherapist – Encouragement and motivation of the patient – Check-up on the adherence to standardized orders of care protocol – Early detection and treatment of complications – Patient examination: orthostatic blood pressure test, oxygen saturation, orientation, auscultation of cardiac, and pulmonary sounds, any additional examination as needed, evaluation of mobility – Mobilizing the patient – Setting the goal for rehabilitation – Careful evaluation and adjustment of medications – Evaluation of calcium and vitamin D intake and supplements – Orders on examinations needed after discharge (for example, on memory disorder and osteoporosis)
Instructions and suggestions to discharge destination
– Objectives of treatment and rehabilitation – Physical status at discharge – General instructions on mobilizing (including active walking exercises, encouragement toward independency) – Nutritional plan including supplements – Medications plan and instructions on discontinuation of opiate pain medications – Planned examinations and follow-ups after discharge – Separate discharge documents from all disciplines (geriatrician, orthopedic, nurse, and physiotherapist)
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