Hospital General Universitario Gregorio Marañón

Our hospital is a public universitary academic center located in the center of Madrid and it is one of the predominant and largest hospitals in our city, attending approximately 750.000 inhabitants. It provides for more than 50 medical, surgical and central services to the community.

The Hip Fracture Unit at the Gregorio Marañón General University Hospital is a professional team made up by Traumatology (surgeons and ward nurses), Geriatrics (physicians and a geriatric specialized nurse), Anesthesiology, Nutrition, Rehabilitation (physicians and physiotherapists) and Social workers. We attend approximately 400-450 patients older than 64 years admitted for hip fracture at the Department of Orthopedic Surgery each year since 1997.

 

Our activity is divided into 3 areas: care activity, teaching and investigation.

The care activity covers: Hip fracture Unit, Orthogeriatric unit and the Orthogeriatric outpatients clinic.

 

1. Hip fracture Unit

We assess patients from the first moment and care for them throughout their hospitalization, sharing clinical responsibility with surgeons. In the daily meetings with the rest of the team members, we establish a specific plan for each of the patients and check daily how they are being complied with, following the specific protocols of the Unit (pain, anemia, delirium, constipation, malnutrition, functional recovery and social helps).

All patients receive specific assessment of falls and recommendations to prevent further falls, as well as personalized treatment for the secondary prevention of new fractures. Their Primary Care physicians receive our medical report from the patient where we share their medical information, as well as their treatment goals.

In addition, patients under 75 years of age undergo bone densitometry and are referred to the rheumatology clinic.

We are participating from the beginning in the Spanish National hip fracture Registry and we also have our own database, in which we collect several baseline variables from medical records and patient clinical evaluation. These

included previous hip fracture; prefracture living situation; and history of diseases, dementia and polypharmacy. Time from admission to surgery (in hours) was recorded in all cases.

In this way, the management of older patients admitted to hospital after suffering hip fractures reduces their risk of perioperative complications, length of stay, functional decline, and mortality as well as healthcare and social costs.

Furthermore, our multidisciplinary team designs a tailored rehabilitation plan with the aims of reducing institutionalization and facilitating functional recovery and return to the patients’ prefracture social situation. All patients who previously walked are evaluated by Rehabilitation and if they are clinically stable, they go to the gym every day. They are also taught functional stimulation exercises to perform in the room together with their family members or caregivers.

 

2. Orthogeriatric Unit

Those patients who need a longer period ofrehabilitation treatment, are referred to our Orthogeriatric unit. It is located in another nearby building and the responsible medical team is made up of geriatricians, rehabilitators, nutritionists and social workers. The objectives in this unit are functional recovery, pain control, health education and secondary treatment of osteoporosis and falls.

 

3. Orthogeriatric Outpatint Clinic

We have a specific Orthogeriatric outpatient clinic one day a week, where we assess patients 2-3 months after hospital discharge. We especially ask about new falls, the presence of pain, adherence to treatment for osteoporosis, functional recovery and any other clinical problems that may have arisen during hospital stay. Both the patient and their Primary Care doctor receive a detailed report with all the recommendations.

 

4. Consults to other fractures:

Although our main goal is hip fracture, we also attend to older people with different fractures that require hospital admission. Geriatricians also make a

discharge medical report that they share with their Primary Care physicians and assess specific treatment related to pain and osteoporosis. We could also use our clinic and the Orthogeriatric unit if needed.

We have been continuously improving our multidisciplinary protocols and clinical pathway to update and standardize the process in our center.

In Teaching, we deeply train specialists in Geriatric Medicine with a four-year program and this is carried out since 1999. Our residents spend four months in our orthogeriatric care unit In addition to that, we teach medical students (at the latest stage of their degree) and PhD students.

In the Research field, we would highlight that we have been awarded with relevant public (Ministry of Health / Ministry of Education) and private grants from institutions. We participate in both national and international scientific meetings.