Using a triggered endocrinology service consultation to improve the evaluation, management, and follow-up of osteoporosis in hip-fracture patients.

BACKGROUND: Nearly 2 million osteoporosis-related fractures occur yearly in the United States, with more than 400,000 requiring hospital admissions. Fewer than 30% receive proper evaluation and care for osteoporosis, representing a large opportunity to enhance secondary prevention of fractures. Methods to improve identification and triage of hospitalized fragility-fracture patients are desirable. METHODS: A multidisciplinary team was created, and definitions were established for an evidence-based best-practice protocol to assess, treat, and document an osteoporosis diagnosis and triage patients with hip-fragility fractures on the basis of the best-practice recommendations from The Joint Commission and the National Osteoporosis Foundation. The team initiated a preauthorized osteoporosis consultation from the endocrinology service for hip-fracture patients, "triggered" via a brief query in admission orders or by the orthopedic service nurse practitioner. Osteoporosis consultations used a consultation template reflecting the protocol. RESULTS: Data were analyzed for 71 baseline patients and 61 intervention patients. The groups possessed similar age, gender, race, and body mass index characteristics. The baseline (on-demand consultation) group suffered from poor performance, with only 3%-21% of patients receiving the desired evaluation, documentation, treatment, or outpatient follow-up. Intervention (triggered-consultation) patients improved markedly postintervention, With performance increasing by 52%-76% on all parameters except outpatient follow-up, which changed insignificantly (6%-15%). CONCLUSION: Although triggered consultation was effective, multimodal layered interventions may achieve even better results and address several identified barriers.

Increased microvascular flow and foot sensation with mild continuous external compression.

Intermittent pneumatic compression of the calf and foot increases inflow to the popliteal artery and skin. We hypothesize that mild, continuous pneumatic compression of the lower extremities of type 2 diabetic patients increases microvascular blood flow to skin (SBF) and muscle (MBF) and improves sensation in feet. Data were collected on 19 healthy volunteers and 16 type 2 diabetic patients. Baseline values of SBF, MBF, and foot sensation were recorded in one leg. The lower extremity was then subjected to 30 mmHg of continuous external air pressure for 30 min, whereas SBF and MBF were continuously monitored. Sensation was reassessed after pressure was released. During 30 mmHg continuous external compression, the healthy control group significantly increased MBF by 39.8% (P < 0.01). Sensation of the foot in this group improved significantly by 49.8% (P < 0.01). In the diabetic group, there was a significant increase in MBF of 17.7% (P = 0.03). Also sensation improved statistically by 40.2% (P = 0.03). Importantly and counterintuitively, MBF and foot sensation both increase after 30 min of leg compression at 30 mmHg. Therefore, mild, continuous pneumatic compression may be a new approach for treating diabetic patients with compromised leg perfusion and sensation.