Early Appropriate Care and opportunities for integrated care pathwyas in orthopaedic trauma

Abstract

Early appropriate care (EAC) is a treatment protocol for trauma patients with unstable fractures of the thoracolumbar spine, pelvis, acetabulum, and/or femur. The protocol was designed to expedite treatment based on patient physiologic readiness for definitive fracture surgery. In the EAC protocol, patients are aggressively resuscitated and managed by a multidisciplinary team. Upon achieving predefined thresholds for adequate resuscitation, patients undergo definitive stabilization of their fractures with the goal of performing surgery within 36 hours of injury. As an integrated care pathway, the EAC protocol defines a time dependent strategy to trauma care and minimizes complications and reduces cost through a multidisciplinary approach. Adoption of the EAC protocol was achieved through buy-in from all involved parties in the development phase and contributed to subsequent adherence to the protocol. As such, lessons learned from the development, institution and study of the EAC protocol may be applied to other clinical challenges in orthopaedic trauma, including fracture management in high-energy geriatric injuries as well as head injury.