Fracture Care Pathway Allows Patients to Remain in Facilities

Suspected fractures in residents of long-term care (LTC) facilities have the past resulted a transfer to nearby emergency department, but with increased risk exposure COVID-19, alternatives are needed. In response this problem, researchers from Sunnybrook Health Sciences Center Toronto, Ontario, developed fracture pathway that allows patients stable remain at LTC facility. Their works as follows. When patient has suspected fracture, facility sends an urgent request mobile imaging service. A technologist comes facility, usually same day, take X-rays then immediately uploads images for radiologist review. Meanwhile, staff applies brace or splint stabilize injury. Once confirms orthopedic surgeon assesses virtually and instructs on appropriate measures. necessary, can schedule in-person assessment clinic. The grew out larger LTC+ Program, which was established prevent unnecessary transfers hospitals. Data Toronto Paramedic Services found trauma were among top three reasons transferring authors told Caring. “That’s what prompted provide residents,” said Amanda Mayo, MD, MHSc, associate director Centre Quality Improvement Patient Safety Sunnybrook. is one partners program. represents collaboration between hospitals, nursing home medical directors, nurse leaders, physiotherapists, occupational therapists, surgeons, physiatrist, quality-improvement specialist. team created educational handouts, videos, case reports, supplied stabilization braces splints participating facilities. “Each site had be little tailored make sure it worked their own environment,” Dr. Mayo said. Biweekly meetings held, small refinements made “We started before we expanded everyone comfortable running anticipated,” apply fractures, such wrist, elbow, ankle. “It simple, straightforward stable,” Genny Ng, RRT, Sunnybrook’s manager quality safety first author study. excluded more serious injuries pathway, including “hip open shoulder dislocations, well limb visible large deformities, neurologic compromise, ongoing pain not controlled by analgesia, and/or compartment syndrome.” Another consideration whether follow residents’ families’ goals care. “Some clearly define they never want go department; surgical intervention,” “And so considered treated well.” evaluating 17 individuals referred than half upper extremity fractures. None needed transferred department surgeons able manage nearly virtually. This offers additional advantage families, namely cost savings outside “Before families accountable two [trips]: second clinic,” Ms. Ng Even instances clinic, there still need less trip. Source: G, et al. Virtual Fracture Care Long-Term Homes Avoiding Emergency Department Visits [published online: February 28, 2023]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2023.01.024.