OTA 2012 Posters
Scientific Poster #20 Hip/Femur OTA-2012
Re-Engineering the Management of Patients with Fragility Hip Fractures
C. Michael LeCroy, MD; Martha Hoskyns, RN, BSN, MHA; Christina McQuiston, MB ChB;
Mission Health System, Asheville, North Carolina, USA
Background/Purpose: Nearly 300,000 Americans sustain a fragility hip fracture each year. An average of 24% of hip fracture patients aged 50 years and over die in the first year following their hip fracture. The purpose of this study was to design and implement a geriatric hip fracture program that would result in standardized hospital care, fewer complications, reduced length of stay, reduced hospital costs, and improved patient education and follow-up care.
Methods: Mission Hospital is an 800-bed tertiary referral center and Level II trauma center located in Asheville, NC. 41 orthopaedic surgeons are on staff, and Mission performs the highest number of hip fracture repairs in North Carolina with approximately 500 cases annually. A program was implemented in 2009 for collaborative management of hip fracture patients, with preoperative hospitalist consultation on all patients over age 64 with a fragility hip fracture. The preoperative process was streamlined with concentrated efforts to get patients to the operating room as soon as possible. The patients were comanaged postoperatively, with the hospitalists focused on reducing medical complications, improving pain management, and reducing delirium. Outcomes were followed prospectively and compared to historical data on similar patients treated at our institution.
Results: Implementation of the hip fracture program resulted in decreased door to operating room times, with the average time falling below 24 hours. The average length of stay for hip fracture patients dropped from 6.4 to 5.1 days from 2008 to 2009. The readmission rate dropped from 10% to 8%, and the mortality rate dropped from 2.35% to 0.9% from 2008 to 2009. The hospital net income per case for hip fracture patients improved from –$2100 to +$800 over the same time span.
Conclusions: Collaborative management of patients with fragility hip fractures between orthopaedists and hospitalists does result in improved patient outcomes. Implementation of a geriatric hip fracture program can result in decreased complications and costs of hospital care.• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.