Transforming an orthopaedic unit into an "Age-Friendly" unit through implementation of the American Geriatrics Society's CoCare®: Ortho program.

OBJECTIVE Transform an inpatient orthopaedic unit into an age-friendly unit for geriatric fracture center (GFC) patients. DESIGN Pragmatic dissemination study of a continuous quality improvement intervention with episodic data review. SETTING Large quaternary care university hospital with no on-site geriatrics and no dedicated geriatric inpatient unit. PARTICIPANTS Age 60 and above with fragility fracture of the native proximal femur hospitalized from July, 2017 to June, 2020. INTERVENTION A hospital medicine-orthopaedics co-management model for a geriatric fracture center (GFC) was developed using processes, tools, and education provided by the American Geriatrics Society's AGS CoCare®: Ortho program to support the age-friendly "4Ms" principles: mentation, mobility, medications, and what matters. Delirium reduction strategies included minimizing sleep interruption through changes in blood draw times, order sets for pain management, and nursing education. Mobility specialists were incorporated to improve early mobilization on the orthopaedic unit. MAIN OUTCOME MEASUREMENTS Frequency of weight bearing (WB) on post-operative day (POD) 1 and frequency of delirium among GFC patients on the orthopaedic unit were compared to concurrent GFC patients on other units. RESULTS Frequency of delirium was 26% on the orthopaedic unit vs. 35% on other units (P = 0.055). Frequency of weight-bearing on POD 1 was 84% on the orthopaedic unit vs. 72% on other units (P=0.003). CONCLUSIONS AGS CoCare®: Ortho is an effective dissemination program for establishing a hospital medicine-orthopaedics co-management program and making an orthopaedic unit age-friendly in a hospital without onsite geriatricians or a dedicated geriatrics unit. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.