Vichaiyut Hospital and Medical Center

Vichaiyut FLS

Vichaiyut Hospital and Medical Center is a private hospital located in central Bangkok city.  Initially, orthopaedic patient care team was established in 2014 to review the complete care of hip and knee arthroplasty patients follow as clinical tracer highlights and reported for hospital accreditation process.  A year later, Dr.Sukajan Pongprapai, a rehabilitation medicine expert has been a committee of Thai Osteoporosis Foundation and has run FLS workshops yearly in all regions of Thailand since 2014.  She has setup Vichaiyut FLS and has become a FLS clinical leader since then.

We describe Vichaiyut FLS'  first clinical showcase on January 2014 as an elderly female, 75 year old with medical history of breast & mandible cancer and osteoarthritis in knees who had fell at home.  Seen by orthopaedic physician with the results fracture right neck of humeral and femoral.  Bipolar hip prosthesis was performed a week after falling down.  February 2014, osteoporosis screening was done by DXA.  The results were shown: lumbar spine = 0.696g./cm² with T-score = -2.7 and left femoral neck = 0.542g. / cm² with T-score = -2.4.  Impression was osteoporosis including laboratory test such as completed blood count, serum calcium, liver function, thyroid function and renal function within normal range.

First of all 2^nd fall prevention counseling was provided, she and her family members were enrolled into Capture the Fracture program. Antiresorptive medication was started within 2 months after surgery.  Two years later, 2^nd DXA was performed which the result lumbar spine = 0.803g./cm² with T-score = -1.8, significantly increased (T-score compared to T-score = -2.7 on February 2014) and left femoral neck = 0.524g. / cm² with T-score = -2.6 decreased (T-score compared to T = -2.4 on February 2014). Impression was osteopenia of the lumbar spine and osteoporosis of the left femoral neck.  FLS service still has provided of continuity care until now.  The recently follow up on November 2017, she walked with single cane, no recurrent fracture and still be continued antiresorptive medication (Denosumab 60 mg subcutaneous injection every 6 months).

Thoroughly our FLS database year 2016, 34 hip fracture patients 65% repeated fall in past 12 months and 86% mostly female and 41% of age among 81 - 90 year old. Laboratory investigation, the finding identified two for vitamin D deficiency and one for the secondary osteoporosis due to hyperparathyroidism. We applied Capture the Fracture program to hip fracture clinical pathway. All our hip fracture patients are reviewed medication use, provide fall risk assessment & prevention program and home modification programs to prevent re-fracture and further falls.

Our improvement year 2017 were getting more multidisciplinary team such as dietician, hospital programmer, decorator consultant from outsource SCG^â company etc. , communication system among multidisciplinary team and next year planning to extend vertebral fracture, non-hip &  non-vertebral fracture.