Hip fracture in Auckland: contrasting models of care in two major hospitals

Tha, H. S.; Armstrong, Douglas G.; Broad, Joanna; Paul, Sathish Kumar; Wood, Peter W.

doi:10.1111/j.1445-5994.2008.01721.x

Cited by 13 publications

(14 citation statements)

References 14 publications

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“…30 At the hospital level, an orthogeriatric service in New Zealand reduced hospital stay and increased the rate and promptness of transfers to rehabilitation, without altering 6-month mortality. 17 The 12-month mortality for community-dwelling patients was not associated with length of hospital stay in an orthogeriatric unit in Oslo. 31 An Australian study over a 10-year period showed reductions in 30-day mortality from 12.1% to 8.2%, whereas LOS increased marginally.…”

Section: Discussionmentioning

confidence: 94%

“…[14][15][16] However, evidence for an association between orthogeriatric acute care and longerterm benefits is inconsistent. 12,17,18 The acute phase of care is coming under particularly close scrutiny in national audit programs that document compliance with recommended process elements and report comparative rates of short-term outcomes. Performances are compared between health services or, more commonly, between individual hospitals.…”

Section: Introductionmentioning

confidence: 99%

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State of origin: Australian states use widely different resources for hospital management of hip fracture, but achieve similar outcomes

Ireland¹,

Kelly

Cumming

2016

Aust. Health Review

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Objective. Hospital management of hip fracture varies widely with regard to length of stay, delivery of post-surgical care and costs. The present study compares the association between hospital utilisation and costs and patient outcomes in the six Australian states.Methods. The present study was a retrospective cohort study of linked administrative databases for 2530 Australian veterans and war widows aged 65 years, hospitalised for hip fracture in 2008-09. Department of Veterans' Affairs datasets for hospital episodes, residential aged care admissions and date of death were linked. Patient characteristics, hospital utilisation and process data, rates of mortality and residential care placement and delivery of community services were compared for patients from each of the states.Results. There were no significant differences in fracture incidence, patient demographics or fracture type among the states. Adjusted total mean length of hospital stay ranged from 24.7 days (95% confidence interval (CI) 22.3-27.5 days) to 35.0 days (95% CI 32.6-37.6 days; P < 0.001) and adjusted total hospital cost ranged between A$24 792 (95% CI A$22 191-A$27 700) and A$35 494 (95% CI A$32 853-A$38 343; P < 0.001). Rates of referral to rehabilitation ranged from 31.7% to 50.4% (P = 0.003). At 1 year, there were no significant differences between states for key outcome determinants of mortality (P = 0.71) or for the proportion of patients who retained their independent living status (P = 0.66).Conclusion. Hospital resources for management of hip fracture differ substantially among the Australian states. Key medium-term patient outcomes do not show significant differences. A potential for substantial cost-efficiencies without increased risk to patient welfare is suggested.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

State of origin: Australian states use widely different resources for hospital management of hip fracture, but achieve similar outcomes

Ireland¹,

Kelly

Cumming

2016

Aust. Health Review

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“…This time to surgery is similar to previously published data for Christchurch 11 (43.5 hours) and Middlemore Hospital (44 hours). 12 Northshore Hospital has significantly shorter times to surgery (21 hours), with 58% having surgery within 24 hours, which may be due to performing surgery after hours for neck of femur fractures. 12 The percentage of patients having surgery within 24 hours in Dunedin (27%) is similar to Middlemore (26%) and Auckland (24%).…”

Section: Discussionmentioning

confidence: 98%

“…12 Northshore Hospital has significantly shorter times to surgery (21 hours), with 58% having surgery within 24 hours, which may be due to performing surgery after hours for neck of femur fractures. 12 The percentage of patients having surgery within 24 hours in Dunedin (27%) is similar to Middlemore (26%) and Auckland (24%). 13 The main reason for delay in medically well patients was theatre unavailability.…”

Section: Discussionmentioning

confidence: 98%

Orthogeriatrics service for hip fracture patients in Dunedin Hospital: Achieving standards of hip fracture care

Teo

Mador

2012

Journal of Clinical Gerontology and Geriatrics

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a b s t r a c tPurpose: To evaluate the orthogeriatrics service (consult liaison provided by geriatricians on an orthopedics ward) for hip fracture patients in Dunedin Hospital and to assess how well standards of hip fracture patient care were achieved. These standards (adapted from British Orthopaedics Association) include admission to ward within 4 hours, surgery within 48 hours, assessment and care to reduce pressure ulcer risk, access to orthogeriatrics services, and secondary prevention of falls and osteoporotic fractures.Methods: This retrospective audit reviewed patients above age 65 years admitted to the orthopaedic service in Dunedin Public Hospital with a neck of femur fracture between January 1, 2010, and December 31, 2010. Results: There were 144 patients with median age of 86 years. 24.5% were admitted to the Orthopaedics ward within 4 hours: 70.8% had surgery within 48 hours and 73.6% had pressure ulcer assessment completed as per our hospital protocol. One-third was seen by the orthogeriatrics team on the day of surgery or earlier. History of falls was not documented in about one third of patients. Only 20.8% had postural blood pressure measured, and 35.6% of those discharged home had a home visit. About 30% did not have documentation of previous fractures, and one-quarter were not assessed for consideration of bisphosphonate therapy. Inpatient mortality was 9%. Conclusions: Several areas for improvement were identified from this retrospective study. Suggestions for achieving the standards of hip fracture care are provided. Further audit after implementing these changes is recommended.

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“…However, contemporary Australian evidence suggests that an orthogeriatric model of care reduces length of stay (LOS) and can lead to a 45% decrease in the probability of complications such as delirium, congestive cardiac failure (CCF), pneumonia, deep vein thrombosis (DVT), pulmonary embolism (PE), pressure ulcers, arrhythmias, myocardial infarction and mortality. Conversely, Tha et al (2009) argue that the best design and setting of comprehensive hip fracture management in the elderly is unknown. Regardless, the mainstay of treatment is surgical repair and a multidisciplinary, co-managed approach that may maximise patient recovery (Hung, Egol, Zuckerman, & Si, 2012).…”

Section: Introductionmentioning

confidence: 99%

Identifying outcomes associated with co-managed care models for patients who have sustained a hip fracture: an integrative literature review

Lynch

Tower

Venturato

2015

International Journal of Orthopaedic and Trauma Nursing

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Please cite this article as: Genni Lynch, Marion Tower, Lorraine Venturato, Identifying outcomes associated with co-managed, care models for patients who have sustained a hip fracture: an integrative literature review, International Journal of Orthopaedic and Trauma Nursing (2014), http://dx.doi.org/doi:10.1016/j.ijotn.2014.07.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 1 IDENTIFYING OUTCOMES ASSOCIATED WITH CO-MANAGED, CARE MODELS FOR PATIENTS WHO HAVE SUSTAINED

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Hip fracture in Auckland: contrasting models of care in two major hospitals

Cited by 13 publications

References 14 publications

State of origin: Australian states use widely different resources for hospital management of hip fracture, but achieve similar outcomes

State of origin: Australian states use widely different resources for hospital management of hip fracture, but achieve similar outcomes

Orthogeriatrics service for hip fracture patients in Dunedin Hospital: Achieving standards of hip fracture care

Identifying outcomes associated with co-managed care models for patients who have sustained a hip fracture: an integrative literature review

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