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(Editor's Note, this article was updated at 2:27 p.m., Nov. 15, to update the average national patient mortality rates for hip fractures.)
Giving patients the ability to walk again — and seeing the joy on their faces when they do — is the best part of Dr. Paul Naumann’s job.
Naumann, an orthopedic surgeon at Jefferson Healthcare and medical director for the orthopedic department, specializes in hip fractures and hip replacements, common procedures for the increasingly elderly population of Jefferson County.
“Getting people on their feet, you can do it quickly,” Naumann said. “A hip fracture is a great example. A patient comes in unable to ambulate and is in excruciating pain, and the next day they are essentially walking home.”
While a 24-hour turnaround is not always achievable, it is possible, Naumann said, adding that bringing happiness through healing is what he looks forward to each day.
“It is the smiles on the patients and seeing the patients back to the level of activity pre-injury” that makes it all worthwhile, he said.
Naumann said he and his staff have been concentrating on improving outcomes for patients, noting the average mortality rate nationwide for patients who undergo hip surgery is about 15 to 30 percent.
“We haven’t specifically looked at our mortality rate over the past couple of years, but it is probably better than that,” he said.
Naumann pointed to a recent study by Healthgrades — a research firm that provides information about physicians, hospitals and health care providers — that recently awarded Jefferson Healthcare's hip fracture treatment program a 5-star rating. That indicates Jefferson Healthcare’s clinical outcomes are significantly better statistically than expected when treating the condition or performing the procedure being evaluated, a news release stated.
A 3-star rating is given to hospitals not statistically different from expected, while a 1-star rating is given to facilities significantly worse statistically than expected.
The 5-star rating was announced in the “Healthgrades 2019 Report to the Nation,” which can be found at www.healthgrades.com/quality. The report details how clinical performance continues to differ dramatically between hospitals regionally and nationally. Healthgrades evaluated about 45 million Medicare inpatient records for almost 4,500 short-term, acute-care hospitals nationwide to assess hospital performance.
Jefferson Healthcare also has earned the 2018 Patient Safety Excellence Award, and it’s the only hospital in Washington state to receive that distinction.
“It is great to be recognized,” Naumann said. “It gives you that added incentive to come to work. It is not just coming to work for a paycheck. It is more satisfying than that.”
Naumann said the ongoing success of the department, and the hospital, relies upon his staff. He’s joined by fellow board-certified surgeons Edward Eissmann and Alex Herzberg, while other staff members are Jodi Stickler and Gretchen Wambach, physician's assistants, and Jessi Taft, R.N., the clinical manager.
Taft said the department has expanded in the past several years and can provide better care for patients who suffer from hip fractures.
Before Naumann arrived, there was a brief period when no qualified surgeons were on staff at the hospital, and that meant patients with hip fractures had to be shuttled to other facilities for treatment, Taft said. Now a surgeon is available day and night, year-round.
“When a hip fracture comes in, I am the only orthopedic surgeon on call, so I come in and take care of that patient until that patient goes home,” Naumann said. “I really keep an eye on the care of that patient.”
The watchful eyes help to prevent complications that can be life-threatening, Naumman said.
“There is also a lot of care that our hospital has provided in optimizing these patients, and that is key (to mitigating) any complications,” he said.
Common complications include onset of pneumonia, aspiration of the lungs after surgery, patients falling while in the hospital, infections, urinary tract infections, clots in the legs or pulmonary embolisms.
“It's not necessarily the fracture, but it’s the fact that they are immobilized and get a blood clot or get pneumonia or a urinary tract infection,” Naumann said. “Sometimes it is the straw that broke the camel's back.”
During some surgeries, “we preserve the patient's bones,” Naumann said. “The ball and socket joint is preserved by using fixation devices” such as chrome, cobalt or titanium plates, screws or nails. Other patients need an artificial hip socket installed.
“It just depends on the fracture pattern,” Naumann said.
The recovery process from surgery to pre-fall functionality usually lasts about four to six weeks, he said.
“We get them ambulating as soon as possible,” Naumann said, “sometimes a day after surgery.”
Such quick turnaround times would have been unheard of decades ago, Naumann said.
“There have been a lot of gains in material sciences which have helped us out,” he said. “Forty or 50 years ago, you would have been put in traction and left in a bed,” and that put the patient at risk for potentially lethal complications.
The orthopedics staff, and the patients they serve, also benefit from the new facility in which they operate. The department is located on the second floor of the new Emergency and Specialty Services Building — a $21 million, 52,900-square-foot building that opened to patients last October. It was the first major capital project for Jefferson Healthcare since the 1995 expansion of the inpatient medical services.
The new building provides a centralized location with better access to key outpatient services such as emergency services, oncology, orthopedics, cardiology, lab draws and select diagnostic imaging.
The former orthopedic suite consisted of five exam rooms, while the new suite has eight. Additionally, the state-of-the-art medical equipment on site – including a fluoroscope that provides real-time imagery of a hip bone – allows most procedures to be performed in-house without the need to transport patients to other buildings or locations, Taft said.
While still in the old building, patients at times needed to be transported off site, which was both a hassle and a literal pain, Taft said. Now, such inconveniences are no longer necessary.
As the overall population in Jefferson County continues to age, treating hip fractures will become more important, Naumann said.
“The retired population is getting bigger, and we are living longer,” he said.
According to the U.S. Census Bureau, 34.7 percent of Jefferson County’s population was 65 or older in 2016, compared with an average of 14.8 percent of the total population statewide.
“The elderly are fragile in nature,” with hip fractures being the most common type of injuries among them, Naumann said. “Hip fractures, we do probably somewhere between 40 and 50 (annually), but the numbers are going up.”
The best way to deal with hip fractures is to prevent them from happening in the first place, Naumann said.
“I think it is important the primary care doctors are vigilant (and) test for osteoporosis or precursor osteopenia, and medicate them and, at minimum, ensure people are taking vitamin D and calcium that is recommended,” he said.
Osteopenia is a condition in which bone mineral density is lower than baseline. It is considered by health professionals to be a precursor to osteoporosis.
Physical fitness and balance also can ward off falls that cause hip fractures, Naumann said.
“Maintaining fitness can help prevent bone loss and mineral density and hip fractures, but balance is a key issue,” he said.
To help promote health and wellness among the local elderly population, the hospital regularly schedules Tai Ji Quan classes for adults.
“Tai Ji Quan is an evidence-based fall-prevention program for adults,” said Amy M. Yaley, Jefferson Healthcare director of marketing and communications. “We are looking at ways that we can help these patients so that they don't have these occurrences.”
The next series of classes has yet to be scheduled, but a new slate should be released soon, Yaley said.
To provide more information about osteoporosis, Jefferson Healthcare is hosting an educational seminar at 4 p.m. Nov. 15 in the Victor J. Dirksen Conference Room, located on the first floor of the new ESSB, 834 Sheridan St., in Port Townsend. For more information, call 360-385-2200.