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International Journal of Endocrinology
Volume 2010, Article ID 590751, 7 pages
http://dx.doi.org/10.1155/2010/590751
Research Article

Brigham Fracture Intervention Team Initiatives for Hospital Patients with Hip Fractures: A Paradigm Shift

Departments of Orthopedic Surgery and Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA

Received 14 April 2009; Accepted 5 July 2009

Academic Editor: Diane Kamen

Copyright © 2010 Julie Glowacki et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We designed, implemented, and revised the Brigham Fracture Intervention Team (B-FIT) initiatives to improve in-hospital care of fracture (Fx) patients. Effectiveness was evaluated for 181 medical records of 4 cohorts in four successive years of consecutive patients who were admitted with a fragility hip Fx. The Discharge Initiative (DI) (computer-based) includes 1200 mg calcium and 1000 IU vitamin D3 daily. The Admission Initiative (AI) was introduced one year later with reminders for serum 25OHD measurement, initiation of daily calcium (1200 mg) and vitamin D (800 IU), and an order for Endocrinology consultation, with an amendment for a computer-assisted reminder and a dose of D2 (50 000 IU). Initially, the computer-based DI was more effective (67%) than the surgeon-driven AI (33%, P<.001). After introduction of a computer-assisted reminder, AI effectiveness increased to 68%. The marked prevalence of vitamin D insufficiency reaffirms the importance of incorporating vitamin D recommendations in Fx care pathways.