DIFFERENCES IN COMPLICATIONS AND LENGTH OF STAY BETWEEN PATIENTS WITH A HIP FRACTURE TREATED AT AN ORTHOPAEDIC DEPARTMENT AND PATIENTS TREATED AT OTHER HOSPITAL DEPARTMENTS

Abstract

The health care system has to deal with substantial health care costs, which are expected to continue to rise due to the increasingly elderly populations. One way of saving has been a reduction of the amount of beds at hospitals. The consequence is that acute patients inappropriately are admitted to non specialized wards because of limited beds. These patients are also known as ‘outliers’. In this study consecutive patients with a hip fracture treated at the orthopaedic department (n=273) are compared with patients treated at other departments (n=147) according to incidence of complications and length of stay (LOS) before and after introduction of an evidence based clinical pathway. There was no medical difference between the populations. However the strict demands of saving costs, with limited beds, have resulted not only in economic consequences with prolonged hospitalization, but also in patient suffering and inconvenience of postoperative complications because of an increasing number of complications.

Patients treated at non specialized wards had an extra LOS of stay of 3.7 days in the acute hospital settings and furthermore 13.6 days of LOS including rehabilitation compared to patients treated at the orthopaedic department. In addition we consider the implemented evidence based clinical pathway to be successful since the number of complications was reduced. It is a major challenge to establish effective treatment and rehabilitation for patients after a hip fracture aiming to avoid complications and reduce LOS. Theses fragile patients with a hip fracture ought to be treated at the orthopaedic department, or at departments with geriatric and rehabilitation knowledge. Physiotherapists, occupational therapists and nurses specialising in orthopaedics and geriatricians should take an active part in these patients care, to improve the quality of care and patient safety in patients with a hip fracture.