Can Geriatric Hip Fractures be Managed Effectively Within a Level 1 Trauma Center?

Ling, Shi-Neng James; Kleimeyer, Christopher; Lynch, Genni; Burmeister, Elizabeth; Kennedy, Diana; Bell, Kate; Watkins, Leith; Cooke, Cameron

doi:10.1097/bot.0000000000000257

Cited by 15 publications

(9 citation statements)

References 19 publications

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“…The utility and success of such services is well-documented in the literature. 11 - 14 After implementation of an orthopedic-hospitalist comanagement service for patients who were traditionally admitted to the general medicine service, Bracey et al cites a reduction in length of stay by 1.6 days without an increase in 30-day readmission or mortality. This is consistent with the study by Phy et al who noted a reduction in length of stay from 10.6 to 8.4 days and a reduction in time to surgery from 38 to 25 hours under a similar coordination initiaitive.…”

Section: Discussionmentioning

confidence: 99%

Admitting Service Affects Cost and Length of Stay of Hip Fracture Patients

Lott

Haglin

Belayneh

et al. 2018

Geriatr Orthop Surg Rehabil

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Introduction:The purpose of this study was to analyze the effect of the admitting service on cost of care for hip fracture patients by comparing the cost difference between patients admitted to the medicine service versus those admitted to a surgical service.Methods:A 2-year cohort of patients 55 years or older who were admitted to a single level 1 trauma center with an operative hip fracture were included. Patient demographics, comorbidities, admitting service, complications, and hospital length of stay were recorded for each patient. Cost of hospitalization, discharge disposition, and 30-day readmissions were collected. Patients who were admitted to the medicine service (medicine cohort) were compared to those admitted to a surgery service (surgery cohort). Multivariate regression models controlling for age, Charlson comorbidity index (CCI), and American Society of Anesthesiology (ASA) scores were used to evaluate hospitalization costs with a P value of <.05 as significant.Results:Two hundred twenty-five hip fracture patients were included; 143 (63.6%) patients were admitted to a surgical service, while 82 (36.4%) were admitted to the medicine service. Patients admitted to medicine service had greater CCI and ASA scores, longer lengths of stay, and more complications than those patients admitted to surgery service. Linear regression model controlling for age, CCI, ASA score, and time to surgery demonstrates that patients admitted to a surgical service will have 2.0-day (95% confidence interval [CI]: 0.561-3.503; P = .007) shorter admissions with a US$4215 reduction in cost (95% CI: US$314-US$8116; P = .034) compared to patients admitted to the medicine service.Discussions:In our urban safety net hospital, hip fracture patients admitted to medicine service had longer lengths of stay and higher total hospitalization costs than patients who were admitted to surgery service.Conclusions:This study highlights that the admitting service should be an area of focus for hospitals when developing programs to provide effective and cost-conscious care to hip fracture patients.

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Section: Discussionmentioning

confidence: 99%

Admitting Service Affects Cost and Length of Stay of Hip Fracture Patients

Lott

Haglin

Belayneh

et al. 2018

Geriatr Orthop Surg Rehabil

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“…Dedicated clinical pathway use has also been shown to lower the odds of four common complications of hospitalisation after hip fracture: deep vein thrombosis, pressure ulcers, surgical site infection and urinary tract infection . Multidisciplinary models of orthogeriatric care can improve outcomes and decrease inpatient complications following hip fracture, particularly for the elderly . Integrating the orthogeriatrician into the care plan for hip fracture patients provides an opportunity to identify and reduce risk factors pertinent to these frail patients at risk of delirium and other common geriatric complications, while monitoring for poly‐pharmacy and drug interactions that may occur during pain management in the acute peri‐operative period.…”

Section: Methodsmentioning

confidence: 99%

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

et al. 2017

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Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly. There is consistent evidence that regional nerve blocks can effectively reduce pain associated with hip fracture, providing rapid-onset, site-specific analgesia that is more effective than standard systemic analgesia alone. There is also moderate evidence that nerve blocks may contribute to reduced rates of delirium, and some suggestion of reduced length of inpatient stay, morbidity and mortality, although limited evidence is available. Fascia iliaca blocks are emerging as a block of choice, with evidence they can be safely and rapidly administered under ultrasound guidance in the acute setting, by both trained medical and nursing staff, with good effect. Ideally, comprehensive pain protocols for elderly hip fracture patients are required, that integrate evidence-based fascia iliaca block use, timely and repeated pain assessment, and multidisciplinary orthogeriatric patient care.

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“…Coordination is described as the means to deliver a plan of care to patients following hip fracture that involves the organization of medical and multidisciplinary teams to the deliver best practice care (Coventry et al., 2017; Holte et al., 2015). Nine studies reported coordination as a feature of the APN role (Collinge et al., 2013; Coventry et al., 2017; Doshi et al., 2014; Holte et al., 2015; Lau et al., 2013; Lin et al., 2009; Ling et al., 2015; Lynch et al., 2015; Pickles et al., 2014) (Table 3; Table S1). Coordination was a key function and involved: case management; organization of medical teams for perioperative optimization; management of the hip fracture clinical pathway; and implementation of essential resources and services post discharge.…”

Section: Resultsmentioning

confidence: 99%

Exploring the roles of advanced practice nurses in the care of patients following fragility hip fracture: A systematic review

Allsop

Morphet

Lee

et al. 2020

Journal of Advanced Nursing

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Aim This study aimed to explore the role and impact of advanced practice nurses (APNs) in care of patients following fragility hip fracture by systematically reviewing the available evidence. Review Design Systematic review. Data sources A search of the databases Ovid Medline, CINAHL, Embase, Emcare, Cochrane Library, and Google Scholar was conducted from January–February 2019. Method This systematic review adhered to The PRISMA Statement. Study selection was managed using the Covidence software platform and quality was assessed using JBI Critical appraisal tools. Studies included adults >18 years and described the role and impact of APNs in care of patients following fragility hip fracture on clinical and non‐clinical outcomes. Results There were 19 papers identified that met the inclusion/exclusion criteria. Quality was graded as moderate to low risk of bias. Six characteristics of APNs were identified: (1) coordination; (2) collaboration; (3) education; (4) assessment, investigation and treatment recommendations; (5) discharge planning, support and follow up; and (6) documentation. Overall mortality and LOS improved when characteristics of the APN role were present. Conclusion Key findings from this systematic review showed: (1) The APN title and role are not clearly defined, but characteristics of the APN role are evident; (2) characteristics of APNs promote the delivery of best practice hip fracture care and have a positive impact on mortality and LOS; and (3) innovative service delivery models involving APNs should be considered to address future projections of hip fracture rates and improve outcomes. Impact This systematic review provides evidence of the role characteristics of APNs in fragility hip fracture and the impact of the role on outcomes. Findings from this research could be used to develop service delivery models using APNs to care for patients following fragility hip fracture and to inform practice where APN roles may improve outcomes for other patient cohorts.

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Can Geriatric Hip Fractures be Managed Effectively Within a Level 1 Trauma Center?

Abstract: Therapeutic level III. See Instructions for authors for a complete description of levels of evidence.

Cited by 15 publications

References 19 publications

Admitting Service Affects Cost and Length of Stay of Hip Fracture Patients

Admitting Service Affects Cost and Length of Stay of Hip Fracture Patients

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

Exploring the roles of advanced practice nurses in the care of patients following fragility hip fracture: A systematic review

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