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Orthogeriatric units, a model of successful hospital collaboration
Las unidades de ortogeriatría, un modelo de colaboración hospitalaria exitosa
A. Capdevila-Reniu
Unidad de Geriatría, Servicio de Medicina Interna, Hospital Clínic de Barcelona, Barcelona, Spain
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Capdevila-Reniu" "autores" => array:1 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Capdevila-Reniu" "email" => array:1 [ 0 => "aicapdev@clinic.ub.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Geriatría, Servicio de Medicina Interna, Hospital Clínic de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las unidades de ortogeriatría, un modelo de colaboración hospitalaria exitosa" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoporotic fractures of the femoral neck are the frailty fractures that entail the most hospital admissions, the most associated medical complications during hospitalization and during the functional recovery period and, therefore, higher costs for the healthcare system. In 2012, there were 35,000 fractures in Spain, and the number of admissions is expected to grow in the coming years, due mainly to the increased life expectancy of the population and to the increased complexity of these patients.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Since the mid-20th century in the United Kingdom, a need was detected to establish collaborations between medical and surgical departments (trauma and internal medicine/geriatric medicine). These collaborations initially consisted of the interconsultation-on-demand model; subsequently and especially in the last 10–20 years, orthogeriatric units have been implemented.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Orthogeriatric units are organized based on medical-surgical co-management, sharing the responsibility for the clinical progression among various practitioners involved in the care of elderly patients with fractures. The patients can be hospitalized in internal medicine/geriatric medicine departments or in trauma departments, depending on the protocols and organization of each healthcare center.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main objectives of this organizational system are to optimize patients for surgery, reduce medical complications before and after surgery, decrease the mortality rate associated with fractures and improve functional recovery. Another benefit of the collaboration has been the optimization of healthcare resources, such as performing early surgery, reducing hospital stays and creating joint protocols for the most common procedures in these patients (transfusions, anticoagulant therapy, prevention of infections, handling of osteoporosis and secondary prevention of new fractures, pain control, etc.).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The implementation of orthogeriatric units in Spanish healthcare centers has increased in recent years and is currently a widespread form of health care. To improve the care of these patients, the Spanish National Hip Fracture Registry was created in 2017 with the endorsement of 21 scientific societies and more than 50 participating hospitals, the results of which will soon be published.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The study presented in the Revista Clínica Española by Dr. Rincón Gómez et al., “Hip fracture co-management in the elderly in a tertiary referral hospital: a cohort study”, gathers the main data regarding the admission of patients older than 65 years with hip fractures and compares them with those obtained 2 years prior to and 2 years after the implementation in 2008 of the Orthogeriatric Unit of Hospital Virgen del Rocío. Although improvements were not found in organizational issues (surgical delay, hospital stay, etc.) and adverse events at discharge (readmission, 30-day mortality), the authors did demonstrate a significant reduction in the number of medical complications and adverse events during hospitalization, with a reduction in hospital mortality (from 4.6% to 1.3%) higher than the expected mean and with better resource optimization due to the creation of healthcare treatment protocols (anemia, pain control, fluid therapy, treatment of osteoporosis, etc.). It is likely that should the authors analyze the results 10 years after the founding of the orthogeriatric unit, they would find even better results resulting from the experience gained in the unit’s operation, as has been demonstrated by various publications in countries with greater experience with this medical-surgical collaboration.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This model of successful collaboration should be extended to other surgical conditions, to thereby achieve a comprehensive approach for elderly patients with multimorbidity and decrease the rates of adverse events and reduce healthcare costs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Capdevila-Reniu A. 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