Building and Sustaining Co-Management Programs in Hospital Medicine: A Technical Report and Operational Guide-Appendix D

Appendix D - Example of a Clinical Pathway

Pdf Summary

This document outlines an example clinical pathway for managing hip fractures within a hospital co-management model. It details a coordinated care approach involving multiple teams, including emergency department (ED), orthopedic surgery, and hospitalist co-management services, to optimize patient outcomes from admission to discharge.<br /><br />**Admission Process:**<br />- Hip fractures occurring in community settings or nursing facilities lead to emergency department admissions.<br />- After imaging confirms a hip fracture, a clinical pathway is activated.<br /><br />**Emergency Department Protocol:**<br />- The ED team pages orthopedic surgery and regional anesthesia teams and completes trauma screenings.<br />- Admissions are categorized for either orthopedic surgery or general medicine based on criteria.<br />- Initial care involves pain management, regional anesthesia, and necessary lab tests (CBC, CMP, INR/PT), among other protocols.<br /><br />**Orthopedic Surgery Service:**<br />- Manages intraoperative and postoperative care, conducts osteoporosis workups, and coordinates with fracture liaison services.<br />- Oversees pain management, diet and activity orders, and VTE prophylaxis.<br />- Works closely with case managers or social workers for discharge planning and coordination.<br /><br />**Co-Management or General Medicine Hospitalist Role:**<br />- Performs preoperative risk assessments and manages preoperative diagnostics and medical conditions.<br />- Handles medication reconciliation and addresses delirium prevention and patient education.<br />- Communicates with the orthopedic surgery team to ensure smooth workflow and mitigates any delay in surgery due to medical optimization.<br /><br />**Discharge Planning:**<br />- The orthopedic surgery service leads discharge processes, including the discharge summary, patient instructions, and follow-up appointment scheduling.<br />- Coordinates with co-management hospitalist for medication reconciliation and updates to the patient's family as needed.<br /><br />This pathway exemplifies the collaborative framework designed to enhance the multidisciplinary care of hip fracture patients throughout their hospital stay.

Keywords

clinical pathway

hip fractures

co-management model

emergency department

orthopedic surgery

hospitalist services

patient outcomes

discharge planning

multidisciplinary care

pain management