The risk of falls and hip fractures increases with age and is more prevalent in women than men. There are about 300,000 hip fractures a year in the United States, and our aging population suggests this number will continue to rise.
Orthopaedic and trauma surgeons at Endeavor Health are one of the highest volume centers in the country, performing more than 1,000 hip fracture operations a year across all hospitals.
Research has shown that patients who go home following surgery in general do better than those who go to a skilled nursing center for recovery. In 2024, a team at Endeavor Health developed the “Home Run Initiative” to help more patients recover at home, reversing the longstanding practice of discharging most hip fracture patients to a nursing facility.
“We see this as a unique opportunity to improve how we take care of patients,” said Endeavor Health orthopaedic trauma specialist Alexander Crespo, MD. “We already have a system in place at our specialized Orthopaedic & Spine Institute at Endeavor Health Skokie Hospital with a distinct, multidisciplinary approach to caring for patients.”
Goals of the Home Run Initiative piloted last year include decreasing readmission rates and improving patient experiences — in short, patients are happier and safer recovering at home rather than in a nursing facility.
Dr. Crespo and colleagues from surgery, nursing, social work, physical therapy and more, as well as physician assistants, conduct organized rounding to see every patient with a hip fracture. “We talk to them with the goal of truly learning about them and understanding what we can do to help them recover at home,” he said.
The team considers everything from whether an outside caregiver will be needed, to how many stairs the patient has to use to get into the house and to a bathroom. They develop individual physical therapy plans and tailor recovery strategies to each patient’s personal setting.
The Home Run team also provides help with different tasks like ordering equipment for patients who need to temporarily convert the first floor of their home to include a bed. For the first 2-3 weeks, they coordinate visiting nurse services to check on incision healing, medication and daily physical therapy visits.
The subspecialized orthopaedic geriatric medical team has critical experience dealing with older patients, the vast majority of whom have osteoporosis, explained Dr. Crespo. Patients who come in for hip surgery after a fall have vastly different needs than those who have a scheduled hip replacement procedure that they had time to plan for.
Bone health specialists meet with patients to consider medication and other strategies to prevent future fractures. Home health specialists conduct safety checks at home to optimize patients’ living spaces and remove risks for further falls.
Social work specialists are there to help people manage fear and anxiety, which is especially important for some of the most vulnerable older and frail patients.
“We’re trying to change the old rule that a broken hip equals time in a nursing home,” said Dr. Crespo. “We have the tools to do things differently and our patients are happier and recovering more successfully at home.”
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