Operated in 48 hours: Ministry of Healthcare of Tatarstan presents a new system for working with hip fractures

Referrals to high-tech centres can (and should) be demanded

Every year, about a thousand residents of Tatarstan suffer from the consequences of fractures of the proximal neck of the femur, First Deputy Minister of Healthcare of the Republic of Tatarstan Almir Abashev said on 7 June.

“For various reasons, the untimely provision of medical care to these patients leads to deep disability, and often to death," he said.

But high-tech operations performed within two days from the moment of injury can return a person to their usual way of life.

Tatarstan has the opportunity to perform such operations, the ministry of healthcare of the republic announced. Such operations will be performed in five medical institutions within 48 hours. Here is a list of them (three in Kazan, one in Naberezhnye Chelny, one in Almetyevsk):

• Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan;
• City Clinical Hospital No. 7, Kazan;
• Emergency Medical Service Hospital, Naberezhnye Chelny;
• Medical sanitary station of Tatneft PJSC, Almetyevsk;
• City Clinical Hospital No. 7, Kazan;

Basically, we are talking about the elderly, and it is necessary to take care of them taking into account the possibility of such operation, Abashev explained. If an elderly person is injured as a result of a fall, then after calling an ambulance, it is necessary to insist on an operation in one of these centres within 48 hours. The decision to perform the operation must be made in the centre itself, the task of the primary care is to identify the fracture and deliver the patient.

The order of the ministry of healthcare establishes: when it is a house call to an elderly patient, if there is at least one diagnostic criterion, the doctor or paramedic immediately makes a preliminary diagnosis of “hip fracture”, and this is an absolute indication for emergency hospitalisation. In this case, ambulance crew takes the injured to the nearest suitable injury care centre. They confirm the diagnosis within two hours.

If possible, ambulance crew can take the patient directly to one of the organisations from the list above, if not, the patient should be sent there as soon as possible (as Chief Traumatologist of the ministry of healthcare of Tatarstan Vladimir Belyakov added, no more than in 12 hours), unless there are contraindications to transportation. In any case, the patient must be operated on in a high-tech medical centre within 48 hours.

The operation itself is not an innovation — depending on the training of a surgeon, it is carried out in an hour and a half. The innovation is in the organisation, to make sure that the patient is operated on within 48 hours.

“We have identified those responsible at each stage of providing medical care. Chief doctors — sorry for the simplicity — are now responsible for that they have a patient in their area of responsibility without providing timely medical care," Abashev said.

He stressed that not only employees of medical institutions should know about the possibility and necessity of such operation, but also those who have elderly relatives in order to demand a referral to a high-tech centre in time. If suddenly the doctor does not give such referral, you can call the hotline of the ministry of healthcare of Tatarstan or even just dial 122, Almir Abashev recommended.

The representatives of the ministry of healthcare found it difficult to answer how unique such system is for Russia. News about similar initiatives can be found in Moscow and Moscow Oblast, Khabarovsk Krai, and Magadan Oblast, but there is no talk of such rigid framework and norms.

One femoral neck fracture occurs every five minutes in Russia

As Vladimir Belyakov explained to journalists, it is quite easy for an elderly person to get such fracture — just when falling from a height of their own height, and sometimes even just when turning over in bed. The number of patients with such fractures will grow by about 5% a year — because the average life expectancy is growing.

If the patient is not operated on and left at home, the mortality rate within a year in such patients is 72%. If the operation is performed within two weeks after the fracture, the mortality rate is reduced to 10%. If operated on within 48 hours, the mortality rate is 1,25%.

The chief specialist in medical rehabilitation of the ministry of healthcare of the Republic of Tatarstan, Rezeda Bodrova, said: after the operation, the patient will have several stages of rehabilitation. The first stage is carried out in the same institution where the operation is performed, the second stage can be left there or sent to some other institutions: the State Medical Institution “Hospital for War Veterans” in Kazan and Naberezhnye Chelny, Republican Clinical Neurological Centre, Nekhama sanatorium. These institutions work in the system of compulsory medical insurance, so rehabilitation in them will be free of charge. The third stage is outpatient, patients at this stage can already move independently.

If rehabilitation is started on time, the quality of life in 85-90% of patients is preserved, said Rezeda Bodrova.

“Falls are not only a medical problem, but also a social one," added Ramil Mukhamatdinov, the chief geriatrician of the ministry of healthcare of Tatarstan. “Much in the prevention of falls depends on the arrangement of everyday life, home environment, adaptation of urban environment to the needs of the elderly. According to experts, 33% of people of 60 years and older have a history of falls. Unintentional falls are the fifth cause of death in the elderly.”

In this light, changes are also taking place in the healthcare institutions of Tatarstan, Almir Abashev said. As an experiment, various quality standards are being implemented for the prevention of falls in medical organisations. The most successful experience is then planned to be distributed outside of health care institutions.

In Russia, a hip fracture occurs every five minutes, Mukhamatdinov added. Among those who remain alive, 64% stop leaving the house within a year, and half remain bedridden.

To prevent falls, older people are recommended to exercise regularly, consult with physical therapists, exercise walking, and wear suitable shoes both on the street and at home. It is recommended to always keep one hand free to help yourself when falling.

Vladimir Belyakov said: if a fracture occurrs in bed — it is better to leave the patient as they are until the ambulance arrives, if on the floor — then it is better for the patient to fix the limb before the ambulance arrives. If you try to move yourself, especially alone, it can cause additional injuries.