P-3-05-09
THE DEVELOPMENT OF A REHABILITATION CONTINUUM OF CARE FOR PATIENTS UNDERGOING A TOTAL JOINT REPLACEMENT
John P. Marchin, M.D.; Joan Wagner, R.N.; Barbara Walsh, M.S.; Yolanda Emley, R.N.; Tina Mullins, R.N. (Memorial Hospital of South Bend, Indiana, U.S.A.)
Professionals providing rehabilitation after total joint replacement are currently challenged to deliver more cost effective and efficient care. Many patients who undergo this procedure are elderly and may require special consideration in their recovery. The purpose of our study was to develop a seamless continuum of rehabilitation care with the collaboration of orthopedics, primary care, and rehabilitation services to facilitate the most cost effective and highest quality care. Our transdisciplinary method for developing this protocol utilized a systems approach and the application of quality improvement tools. A core project team included a physiatrist, a rehabilitation nurse admission coordinator, a facilitator, and various other consultants who met regularly for this design project. The results of this study lead to the development of best practice assumptions from which an optimal cam flow diagram was constructed. From this we were able to make specific recommendations for improvement in the delivery of rehabilitation care. A pilot program has been initiated to implement these recommendations. Our conclusion is that a transdisciplinary continuum of rehabilitation promotes more efficient care of patients after total joint replacement.
P-3-05-10
Post-operative walking ability after Ender nailing for trochanteric fracture of the femur in the elderly over eighty years of age.
Akihiro Nakazawa M.D. (Yokohama City University, Yokohama, Japan)
Kazuhiro Suzuki, Naoto Mitsugi, Eiichi Suzuki, Mitani Hidetoshi, Tomihisa Koshino
Post-operative walking ability after Ender nailing for trochanteric fracture of the femur was investigated in the elderly over eighty years of age.
(Materials and Methods) Ender nailing was performed in 49 patients (7 men and 42 women, mean age 87 years) at the Fujisawa City Hospital between January 1989 and December 1995. Stable type according to Evans classification was 31 cases and unstable 18. All cases were able to walk before injury (out door level 25 cases and in door 24). We investigated post operative walking ability of these cases and studied their outcome influenced by age, sex, fracture type, periods until operation, walking ability before injury and dementia.
(Results) Nineteen cases (39%) were able to walk at discharge (out door level 7 cases and in door 12). Age, walking ability before injury and dementia were noted to have firm effects on post-operative walking ability (p<0.01). In the elderly over ninety years of age, only 29% of these were able to walk. Most of those who were able to walk in door only before injury and had dementia, were not able to walk at discharge.
(Conclusion) Age, walking ability before injury and dementia influenced on post operative walking ability.
