The Geriatric Fracture Care program operated by Geisinger Medical Center in Danville, Pennsylvania was recently honored with the highest level of recertification available, Premier Level status, as announced by the International Geriatric Fracture Society (IGFS). According to the July 6, 2016 news release, “In achieving this recognition Geisinger Medical Center becomes just the second such program to achieve this designation in the U.S.”
Geisinger Medical Center Recognized for Fracture Care

“The CORE Certification Program is a global quality improvement initiative designed to recognize the achievements of programs that exceed outcome benchmarks in the management of geriatric fractures. Geisinger Medical Center joins another Geisinger program, Geisinger Wyoming Valley, in receiving recognition from their peers for sustained outcomes that outperform the clinical quality and performance improvement benchmarks as identified by the IGFS, over the past two years.”
In making the announcement, Simon Mears, M.D., Ph.D., from the University of Arkansas for Medical Sciences and President of the IGFS, stated “It is fitting for Geisinger Medical Center in Danville to achieve this recognition. As an institution they have invested in patient resources and developed advocates that are committed to advancing the shared mission of our organizations. Their physician and administrative leaders are always willing to educate their peers and utilize their knowledge to advance the treatment of geriatric fractures. Because of their outreach and leadership, countless patients will ultimately be the beneficiaries of improved care pathways and better outcomes.”
Asked about the challenges of working on an interdisciplinary team, Dr. Mears told OTW, “One of the many challenges is keeping up with communication. When a program starts, daily and then weekly communication must occur between the main champions in orthopedics, medicine or geriatrics as well as other stakeholders including nursing, emergency room and anesthesia. Without constant feedback, misunderstandings can happen that lead to problems between the groups. Each of the stakeholders has a different culture and it takes working and time for these to integrate so that each group understands the needs and interests of the others. The process of starting a hip fracture service takes at least six months before you will achieve better processes and improve patient care.
“Elite status as a Geriatric Fracture program requires a lot of effort and commitment by the entire hospital. By working towards certification, you will achieve better outcomes for your patients as well as a true sense of teamwork and accomplishment in making your hospital a safer and more efficient place to work. This process will bring you closer to the other groups in your hospital, especially administration who controls your resources.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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