Abstract
Introduction
The length of hospital stay following a hip fracture has decreased significantly during the past decades. Knowing that a hip fracture patient is often one with several comorbidities and high mortality, is it possible to further decrease the length of stay without compromising the quality of care?
Setting
Prior to November 2007 a hip fracture patient at Svendborg Hospital would be admitted to the orthopedic department. Postoperatively the patient would be treated by the orthopedic surgeons. If needed a geriatric consult could occur. If the patient was eligible she could be transferred to the geriatric department for further rehabilitation.
After November 2007 eight orthopedic beds were dedicated to hip fracture patients, in an orthogeriatric setting. The patient was treated operatively by the orthopedic surgeons, and then a geriatric consultant was responsible for the rest of the stay. Nurses and therapists were dedicated to the care of hip fracture patients, and had recieved special training regarding. The patient would stay in the same bed throughout the hospitalisation.
Material
224 consecutive hip fracture patients prior to November 2007 treated in a classic orthopedic department compared to 224 consecutive hip fracture patients after November 2007 treated in the orthogeriatic department. Of the 224 patients treated prior to November 2007 117 were eventually transferred to the geriatric department.
Result
the overall mean hospital stay in the classic orthopedic department was 17.5 days (range 2–58 days, 95% CI 15.9–18.8 days). Patients (N=107), who were not transferred to the geriatric department had a mean of 8,7 days, whereas those who were transferred had a mean stay of 25,5 days.
After November 2007 the overall mean length of stay was 11.5 days (range 1–38, 95% CI 10.5–11.9 days). The hip fracture patients spent 1,388 less days in hospital when admitted to the orthogeriatric setting as compared to the classic orthopedic setting. The 30 day mortality was 11,3% in the group prior to November 2007 compared to 9,8% in the group after November 2007.
Conclusion
Changing the setting in which hip fracture patients are treated, significantly reduces the overall length of stay (p<0.0000), without compromising mortality. It involves an interdisciplinary setting with dedicated nurses and therapists. The hip fracture patient is first and foremost regarded as a geriatric patient and thus treated postoperatively by geriatric consultants.
