多職種連携による大腿骨近位部骨折治療

Hip Fracture ― Epidemiology, Management and Liaison Service. Multidisciplinary approach for the treatment of proximal femoral fractures.

　高齢者大腿骨近位部骨折に対し，多職種による集学的診療体制を組織した。連携を行う上での各部門内，部門間の問題点を検討し，改善策のコンセンサスを得た上で，各部門におけるマニュアル，ガイドラインを作成した。また専用電子カルテを作成し，院内紹介状を撤廃した。その結果，受診時に全例内科診察を行い，平均手術待機期間は1.3日となった。また，精神科との連携によりせん妄への早期対処が可能となった。退院時骨粗鬆治療薬処方のチェックを病棟薬剤師が行うことにより，退院時処方率は連携開始前の39％から95％へと著しい改善をみとめた。

　Multidisciplinary approach for proximal femoral fracture was organized in the hospital. Inter and intra division obstacles were discussed. After general consensus of the team was obtained, manuals and guidelines of the each division were prepared. In addition to this, the electrical chart specific for the proximal femoral fracture was made which enables to eliminate in-hospital reference letters. As the results, all patients were examined by internal medicine doctors at the time of admission. Average interval from the time of admission to surgery became 1.3 days. Closer relationship with psychiatrist made early detection and treatment of delirium possible. After changing the system to check the antiosteoporosis medication at the time of discharge by the ward pharmacist dramatically increased the prescription rate form 39 percent to 95 percent.