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forearm or wrist — and move them into specialist care for rapid treatment. "The Fragility Fracture Service enables us to efficiently triage elderly patients, get them to the operating room within 24 hours of admission, and discharge them within five days of surgery," Dr. Gould says. "The multidisciplinary team provides comprehen- sive care with expert medical supervision and anesthesia support throughout the patients' stay." Co-management Is Best Management Hip fractures are one of the most debilitating — and common — inju- ries suffered by elderly patients. The first 48 hours after hospitalization are critical, and any time lost within this window can affect prognosis, notes Dr. Barzideh. Multiple specialties are involved in the care for such patients, so co-management is vital for effective and timely treatment. "Co-management in these cases is different from the usual model, where orthopedic surgeons or internal medicine specialists direct every aspect of care," Dr. Barzideh says. "We don't ask people to manage aspects of treatment outside of their specialty. Instead, orthopedic specialists spearhead fracture care and medical specialists manage comorbid conditions. Anesthesiologists are also part of the care team, as they are respon- sible for providing safe and effective analgesia to optimize outcomes." Following surgery to repair the frac- ture, the next phase of co-management begins. Since the Fragility Fracture Service opened at Winthrop-University Hospital just over a year ago, hospitaliza- tion times have been reduced to fewer than four days in some cases. Repairing fractures and preventing subsequent injuries and rehospitaliza- tions are dual aims of the Fragility Fracture Service. Orthopedic specialists collaborate with primary care provid- ers to construct plans for managing osteoporotic patients and identifying areas, such as obtaining insurance approvals for medications or services, in which patients may need assistance. "The Fragility Fracture Service allows dedicated and focused care for elderly patients, which demonstrates Winthrop- Universit y Hospita l's commitment to making this patient population a priority," Dr. Gould says. "Other hos- pitals don't always provide this level of attention to geriatric trauma patients, so having this resource available is a boon to the community." Treating the Young End of the Spectrum Pediatric specialists at Winthrop- University Hospital provide collaborative care to treat the spectrum of trauma-related orthopedic injuries in children. "This isn't just a one-service shop," Dr. Gaffney says. "When we admit chil- dren, the interaction with their families includes the nursing staff and discharge planning. Attending physicians lead the care team when the child's pediatrician doesn't work at Winthrop-University Hospital, and pediatric orthopedic specialists maintain close relationships with the medical team to complete the care continuum." Upon a child's admission, the team constructs treatment plans, coordinates specialist care, arranges rehabilitation services and ensures that families have everything they need while their child is in expert hands. "Family focus is an important com- ponent to pediatric orthopedic care," Dr. Gaffney says. "In other large institu- tions, family-centered care can be lost as children move through the system, but each member of the pediatric medical team goes above and beyond to ensure families are cared for and kept abreast of medical decisions." A 'Window to the Community' Multidisciplinary care begins when patients arrive at the 4,500-square-foot Pediatric Emergency Unit. The facility is part of Winthrop-University Hospital's Emergency Department but features a separate entrance for children and fami- lies, 10 dedicated pediatric beds, and two isolation rooms. "The Pediatric Emergency Unit is our window to the community," Dr. Gaffney says. "It's the first stop children make when they receive orthopedic trauma care here. Pediatric orthopedic surgeons maintain close contact with providers in the Pediatric Emergency Unit. Anytime there is a question about moving children to specialist care, they call me directly. We construct a care plan to stabilize and manage the injury until orthopedic specialists can see them in a more clinical setting." Collaboration between orthopedic specialists and pediatricians who deliver care in the Pediatric Emergency Unit is vital to providing rapid care and sending patients to necessary specialists for further Dr. Gaffney evaluates a pediatric orthopedic patient. SPECIAL CLINICAL SECTION: ORTHOPEDICS M D N E W S . CO M n MD NEWS Long Island | 1 7