Fair Healthcare Practices in Orthopedics Assessed with a New Framework

Perioperative and Postoperative Outcomes of Proximal Hip Fracture: A Comparison of Orthopedic and Geriatric Care Models

Introduction Orthogeriatric patients with femur fractures, despite their multiple comorbidities and associated healthcare costs, have a promising new approach. This approach suggests that most patients should be hospitalized in the geriatric department, with daily orthopedic follow-up. The potential for lower mortality rates through orthogeriatric co-management and dual care is a reason for hope in our field. Methods This study is retrospective and involved 285 patients with proximal hip fractures. Two treatment models were compared: hospitalization in orthopedic and geriatric departments with different treatment protocols. The study analyzed demographic data and postoperative outcomes. It also included an analysis of 26 patients who received conservative treatment. Results Our study revealed significant differences between patients hospitalized in the orthopedic and geriatric departments. Geriatric department patients, who were significantly older and had higher comorbidities, experienced extended hospitalization and higher mortality rates during hospitalization, at 30 days, and at one-year follow-up (p<0.05). Notably, a significantly higher proportion of geriatric patients were discharged to home rehabilitation at the end of hospitalization compared to orthopedic patients (17.5% vs. 7.4%; p<0.01). Among non-operated patients, the mortality rate was 57.7% compared to 16.5% in patients who underwent surgery during the one-year follow-up. Discussion Our study suggests that elderly patients with hip fractures may benefit from management in the geriatric department. Despite experiencing significantly longer hospital stays, these patients have a higher likelihood of being discharged home compared to those managed in the orthopedic department. These findings have important implications for the care of orthogeriatric patients and may help guide future treatment strategies.

Evaluation of Community Involvement and Development in an Orthopedic Hospital

Improving healthcare requires appropriate community involvement supported by appropriate partner engagement methods. This research aims to develop a complex tool for evaluating the social responsibility of health facilities regarding community involvement and development. We developed areas of a new reference framework for the sustainability of healthcare organizations, which includes the area of community involvement and expansion. It is made up of nine indicators. These were designed using the most representative activities reported by hospitals around the world. Their testing was conducted in an orthopedic emergency hospital. The designed indicators are community engagement actions; the interventions' content adapted to the community; partnership and networking; the involvement of volunteers and training networks; the involvement and participation of professional associations; community-involved local opinion leaders; satisfaction with partnerships; initiatives together with the community; and educational visits. The testing and validation of health practices of the indicators highlighted their adequacy with the proposed purpose of the research and the promotion of sustainable development. We have also verified their compatibility with the requirements of national hospital accreditation legislation and the European framework for quality assurance in hospitals.

Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions

The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp's role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner's understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.

Exploring Ethical Challenges in Orthopedic Practice

Introduction: The foundation of a successful orthopedic surgeon is built upon medical expertise intertwined with ethical responsibility, where patient care and professional integrity are inseparable. Orthopedic surgeons encounter multifaceted ethical considerations, often navigating gray areas not explicitly addressed in medical education.[1] These challenges demand adherence to well-defined guidelines and continuous learning through peer interactions, conferences, and practical experience. Understanding the nuances of ethical dilemmas is vital, as what may be considered ethical in one context can be deemed unethical in another, influenced by factors such as age, occupation, and financial considerations.[2] Key Ethical Principles and Ethical Decision-Making: Orthopedic practice is guided by key ethical principles, including honesty, confidentiality, professional behavior, informed consent, and respect for patient autonomy. Upholding these principles fosters trust between patients and health-care providers, facilitates effective communication, and empowers patients to participate in their treatment decisions. Ethical dilemmas in orthopedic practice must be understood through evolving ethical principles. Deontological principles emphasize fulfilling professional obligations, while utilitarianism prioritizes actions that maximize benefits for the greatest number of individuals.[3] Orthopedic surgeons must skillfully apply these frameworks to make ethically sound decisions, considering both individual patient needs and broader societal implications.[4]. Patient Welfare and Continuous Learning: Orthopedic surgeons must stay abreast of evolving medical knowledge to provide the best care to their patients. This commitment is not just a professional obligation but a moral imperative rooted in the ethical duty to prioritize patient welfare. Failing to update one’s medical knowledge compromises patient care and violates the ethical principle of beneficence.[5] Therefore, ongoing education is essential for maintaining ethical standards in orthopedic practice. While continuing to learn and adhere to ethical orthopedic practice, surgeons must also balance their professional development with financial commitments. Industry Collaborations and Ethical Integrity: Orthopedic practice sometimes intersects with industry support, presenting both opportunities and ethical challenges.[4] While industry collaborations can provide valuable resources and progress, they also pose risks to ethical integrity. Surgeons must approach these collaborations with caution, ensuring that professional decisions remain independent and patient-centered. Conflicts of interest, biased research results, and undue influence on medical decision-making are ethical pitfalls that should be avoided. A balanced approach that prioritizes patient welfare without compromising quality is essential for navigating collaborations with pharmaceuticals and implant industries. Broader Ethical Challenges in Healthcare: Beyond orthopedic practice, the health-care industry faces numerous ethical challenges, including patient rights, conflicts of interest, and access to care.[4,6] Addressing these challenges requires a commitment to ethical integrity and the promotion of equitable health-care policies. Orthopedic surgeons play a crucial role in advocating for ethical practices and policies that prioritize patient welfare. Conclusion: Ethical considerations serve as guiding principles in orthopedic practice, shaping clinical decisions and professional conduct. Balancing patient comfort, quality of life, and family wishes requires sensitivity, empathy, and ethical discretion. As orthopedic surgeons deal with ethical dilemmas, they can maintain the trust of their patients and contribute to a health-care system rooted in ethical integrity and patient-centered care.

An Orthopedic Healthcare Facility Governance Assessed with a New Indicator System

BACKGROUND AND OBJECTIVES

A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of this research is to develop a new complex tool for evaluating healthcare facility governance as a component of social responsibility, integrated into sustainability.

MATERIALS AND METHODS

We designed the research to develop the domains of a new reference framework for evaluating healthcare facility governance. The methodology for designing the indicators that make up the new reference framework consists of collecting and processing the most recent and relevant practices regarding the governance of healthcare facilities that have been reported by representative hospitals around the world.

RESULTS

We designed eight indicators that are brought together in the healthcare facility governance indicators matrix. They have descriptions and qualitative and quantitative rating scales with values from 0 to 5 that allow the degree of fulfillment to be quantified. The importance of the indicators is evaluated on a specific scale described qualitatively and quantitatively by values from 0 to 5. The values of the degree of achievement-importance couples of the indicators allow the development of improvement measures with priority according to the results revealed by the Eisenhower-type assessment diagram.

CONCLUSIONS

Validation in practice of the system of indicators at an emergency hospital in an orthopedic profile highlighted the fact that they can be integrated into other national and international reference frameworks implemented in the hospital. The added value of the implementation consists of the facilitation of sustainable development and the orientation of health personnel, patients, and interested parties toward sustainability.

Assessment of Patient Matters in Healthcare Facilities

BACKGROUND AND OBJECTIVES

Ensuring the sustainability of healthcare facilities requires the evaluation of patient matters with appropriate methods and tools. The objective of this research is to develop a new tool for assessing patient matters as a component of social responsibility requirements that contribute to the sustainability of healthcare facilities.

MATERIALS AND METHODS

We carried out an analytical observational study in which, starting from the domains of the reference framework for the sustainability of health facilities (economic, environmental, social, provision of sustainable medical care services and management processes), we designed indicators that describe patient matters. To achieve this, we extracted from the scientific literature the most recent data and aspects related to patient matters that have been reported by representative hospitals from all over the world. These were organized into the four sequences of the quality cycle. We designed the method of evaluating the indicators based on the information couple achievement degree-importance of the indicator. In the experimental part of the study, we validated the indicators for the evaluation of patient matters and the evaluation method at an emergency hospital with an orthopedic profile.

RESULTS

We developed the patient matters indicator matrix, the content of the 8 indicators that make it up, questions for the evaluation of the indicators, and the evaluation grids of the indicators. They describe five levels for each variable of the achievement degree-importance couple. The practical testing of the indicators at the emergency hospital allowed the calculation of sustainability indicators and the development of a prioritization matrix for improvement measures.

CONCLUSIONS

Indicators designed in this research cover social responsibility requirements that describe patient matters. They are compatible and can be used by health facilities along with other implemented national and international requirements. Their added value consists in promoting social responsibility and sustainable development of healthcare facilities.