scholarly journals Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service

2019 ◽  
Vol 10 ◽  
pp. 215145931989389 ◽  
Author(s):  
R. P. Murphy ◽  
C. Reddin ◽  
E. P. Murphy ◽  
R. Waters ◽  
C. G. Murphy ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Performance Indicators ◽  
Functional Outcomes ◽  
Best Practice ◽  
Standards Of Care ◽  
Fracture Care ◽  
Best Practice Guidelines ◽  
Improve Compliance

Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for patients after hip fractures and can improve compliance with best practice guidelines for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture standards of care was reviewed, and additional outcomes such as length of stay, access to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of stay decreased from 19 to 15.5 days (mean difference 3.5 days; P < .05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%, P < .05), and this happened in a timelier fashion (17.8 vs 24.8 days, P < .05). We found that less patients required convalescence post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in clinical outcomes for older people with hip fractures.

scholarly journals P46 Effect of the COVID-19 pandemic on hip fracture patients in a Teaching London Hospital

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Shamim Umarji ◽  
Rhonda Sturley ◽  
Prodromos Tsinaslanidis ◽  
Caroline B Hing ◽  
Prodromos Tsinaslanidis
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Older People ◽  
Performance Indicators ◽  
Best Practice ◽  
National Database ◽  
Subsequent Reduction ◽  
Equivalent Time ◽  
Operative Care ◽  
Serious Injury

Abstract Introduction Hip fractures are the commonest serious injury in older people, the commonest reason for older people needing surgery and the commonest cause of death following an accident. The NHFD is a national database whereby markers of care are recorded prospectively for patients over 60 years sustaining a hip fracture and requiring inpatient care, with a Best Practice Tariff linked to key performance indicators. The aim of this study was to review how care varied for patients sustaining a hip fracture during the COVID-19 pandemic compared to the equivalent time last year. Methods Using the NHFD we compared data from March – May 2019 to the same period in 2020 during the pandemic at St George’s Hospital. The study provides a snapshot of care during the pandemic. Results There were more admissions and more discharges during the pandemic. There was an increase in time to theatre and subsequent reduction in BPT. There was also an increase in non- operative treatment for these patients. 6 patients were confirmed COVID-19 positive, one of whom died. There was a reduction in time to ortho-geriatrician review and also a reduction in delirium review post-operatively. Length of stay was also reduced. Conclusion The COVID-19 pandemic had an effect on care provided to hip fracture patients. There was an increase in time and a deterioration in orthogeriatric review within 72 hours. The length of stay however improved due to improved focus on pathways and discharge processes. There was also a lower threshold to offer non- operative care wherever possible.

scholarly journals Improving Hip Fracture Care in Ireland: A Preliminary Report of the Irish Hip Fracture Database

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Prasad Ellanti ◽  
Breda Cushen ◽  
Adam Galbraith ◽  
Louise Brent ◽  
Conor Hurson ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Preliminary Report ◽  
Older Persons ◽  
International Standards ◽  
Standards Of Care ◽  
Age Group ◽  
Web Based ◽  
Fracture Care ◽  
Orthopaedic Ward

Introduction. Hip fractures are common injuries in the older persons, with significant associated morbidity and mortality. The Irish Hip Fracture Database (IHFD) was implemented to monitor standards of care against international standards.Methods. The IHFD is a clinically led web-based audit. We summarize the data collected on hip fractures from April 2012 to March 2013 from 8 centres.Results. There were 843 patients with the majority being (70%) female. The 80–89-year age group accounted for the majority of fractures (44%). Most (71%) sustained a fall at home. Intertrochanteric fractures (40%) were most common. Only 28% were admitted to an orthopaedic ward within 4 hours. The majority (97%) underwent surgery with 44% having surgery within 36 hours. Medical optimization (35%) and lack of theatre space (26%) accounted for most of the surgical delay. While 29% were discharged home, 33% were discharged to a nursing home or other long-stay facilities. There was a 4% in-hospital mortality rate.Conclusions. Several key areas in both the database and aspects of patient care needing improvement have been highlighted. The implementation of similar databases has led to improved hip fracture care in other countries and we believe this can be replicated in Ireland.

scholarly journals Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

2021 ◽  
Vol 12 ◽  
pp. 215145932199616
Author(s):  
Robert Erlichman ◽  
Nicholas Kolodychuk ◽  
Joseph N. Gabra ◽  
Harshitha Dudipala ◽  
Brook Maxhimer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Logistic Regression Analysis ◽  
Hip Fractures ◽  
Surgical Procedure ◽  
Hospital Admissions ◽  
Fracture Care ◽  
Increased Risk ◽  
Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

scholarly journals Too Cool? Hip Fracture Care and Maintaining Body Temperature

2020 ◽  
Vol 11 ◽  
pp. 215145932094947
Author(s):  
James Arkley ◽  
Suhib Taher ◽  
Ján Dixon ◽  
Gemma Dietz-Collin ◽  
Stacey Wales ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Temperature Control ◽  
Functional Outcomes ◽  
Surgical Site Infections ◽  
Fragility Fractures ◽  
Perioperative Period ◽  
Readmission Rates ◽  
Comprehensive Review ◽  
Fracture Care ◽  
Increase Risk

Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

OUTCOME PREDICTORS AND SPECTRUM OF TREATMENT ELIGIBILITY WITH PROSPECTIVE PROTOCOLIZED MANAGEMENT OF INTRACEREBRAL HEMORRHAGE

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. 436-446 ◽  
Author(s):  
Jennifer Jaffe ◽  
Lora AlKhawam ◽  
Hongyan Du ◽  
Kristen Tobin ◽  
Judith O'Leary ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Best Practice ◽  
Initial Assessment ◽  
Consecutive Series ◽  
Best Practice Guidelines ◽  
Management Protocol ◽  
Scale Scores ◽  
Contemporary Management ◽  
Risk Predictors

Abstract OBJECTIVE Risk predictors, spectrum of treatment eligibility, and range of expected outcomes have not been validated in consecutive series including all cases of intracerebral hemorrhage (ICH) subjected to a prospective management protocol based on current guidelines. METHODS Eighty-six cases of ICH were prospectively identified in conjunction with screening for a clinical trial during an 18-month period. All patients were subjected to protocolized management based on published “best practice” guidelines for ICH. Medical records were reviewed by trained researchers, and outcomes were assessed at various time points including latest follow-up (range, 0–24 months; mean, 3.97 months). Initial assessment parameters, treatment eligibility, and outcomes were based on standardized criteria. RESULTS In accordance with past literature, mortality and functional outcomes were significantly worse in older patients, those with a larger ICH volume, and worse Glasgow Coma Scale scores, in univariate and multivariate models. The presence and severity of associated intraventricular hemorrhage also correlated with mortality and outcome. Significantly lower mortality (P = 0.024) and better functional outcomes (P = 0.018) were achieved at 30 days in patients with an ICH volume of less than 30 cm3 in this series than in previously published community-based historical controls without protocolized care. A tight correspondence between treatment eligibility and treatment administered was found. CONCLUSION Previous estimates of poorer outcome in patients with ICH might not apply to contemporary management protocols, especially in patients with a smaller ICH volume. Outcome ranges in various risk categories and modeling of treatment eligibility will help project more realistic prognostication and assist with the design of future trials.

scholarly journals The independent patient factors that affect length of stay following hip fractures

2018 ◽  
Vol 100 (7) ◽  
pp. 556-562 ◽  
Author(s):  
T Richards ◽  
A Glendenning ◽  
D Benson ◽  
S Alexander ◽  
S Thati
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Patient Factors ◽  
Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

scholarly journals Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

2017 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Alastair G. Dick ◽  
Dominic Davenport ◽  
Mohit Bansal ◽  
Therese S. Burch ◽  
Max R. Edwards
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
District General Hospital ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Time To Surgery ◽  
Surgery Mortality ◽  
Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

scholarly journals Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture? — A case-historical control study

2021 ◽  
pp. 1-10
Author(s):  
Dennis Kim Chung Mo ◽  
Ken Kin Ming Lau ◽  
Donna Mei Yee Fung ◽  
Bosco Hon Ming Ma ◽  
Titanic Fuk On Lau ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Functional Outcomes ◽  
Geriatric Patients ◽  
Historical Control ◽  
Hospital Length Of Stay ◽  
Lower Percentage ◽  
Control Group ◽  
Study Group ◽  
Rehabilitation Hospital

Objective: To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training. Methods: A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals. Results: With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II ([Formula: see text]) and significant higher MBI scores ([Formula: see text] deviation, median; Study group: [Formula: see text] points, 51 points; Control group: [Formula: see text] points, 43 points; [Formula: see text]) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: [Formula: see text] points, 7 points; Control group: [Formula: see text] points, 6 points; [Formula: see text]) and MBI scores (Study group: [Formula: see text] points, 68 points; Control group: [Formula: see text] points, 64 points; [Formula: see text]) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: [Formula: see text] days, 7 days; Control group: [Formula: see text] days, 6 days; [Formula: see text]). The average LOS in rehabilitation hospital (Study group: [Formula: see text] days, 20 days; Control group: [Formula: see text] days, 23 days; [Formula: see text]) and total in-patient LOS (Study group: [Formula: see text] days, 26 days; Control group: [Formula: see text] days, 28 days; [Formula: see text]) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, [Formula: see text]). Conclusion: Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.

scholarly journals The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

2019 ◽  
Vol 101 (5) ◽  
pp. 342-345
Author(s):  
J Craik ◽  
R Geleit ◽  
J Hiddema ◽  
E Bray ◽  
R Hampton ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Best Practice ◽  
Complication Rates ◽  
Delayed Presentation ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Total Hip

Introduction Total hip arthroplasty is recommended for elderly patients with fractured neck of femur who are independently mobile, have few co-morbidities and are not cognitively impaired. Providing a daily total hip arthroplasty service is challenging for some units in the UK and considering that these patients may be physiologically distinct from the average hip fracture patient, loss of the best practice tariff as a result of surgical delay may be unjustified. The aim of this study was to determine whether time to surgical intervention for patients eligible for total hip arthroplasty had a negative impact on patient complications, length of stay and functional outcomes. Methods All patients undergoing total hip arthroplasty for fractured neck of femur at our institution over a ten-year period were identified. Complications and functional outcomes were compared between patients receiving total hip arthroplasty before and after 36 hours. Results Of 112 consecutive patients undergoing total hip arthroplasty, 70 responded to a questionnaire or telephone consultation. Four patients were excluded owing to delayed presentation, the presence of advanced rheumatoid arthritis or a pathological fracture. Two-thirds (64%) of the remaining 66 patients underwent surgery within 36 hours of presentation. There were no significant differences between the groups of patients receiving surgery before or after 36 hours with regard to postoperative length of stay, complications, Oxford hip scores or visual analogue scale scores for state of health. Conclusions Delaying surgery for patients eligible for total hip arthroplasty as per the National Institute for Health and Care Excellence guidelines is justified and should not incur loss of the best practice tariff.

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