Abstract

Purpose: Neck of femur fractures increasingly form a large bulk of in-patient admissions to trauma units. These patients often require multi-disciplinary input before discharge. Delayed discharge not only exposes patients to nosocomial infections, it places strain on limited bed numbers. The use of a single screening question at time of admission to identify those patients suitable for fast-track discharge was investigated.

Methods: Prospective study. 122 patients in the study. Basic epidemiological data was collected. At admission the patient was asked whether they were able to do their own shopping or not. Following discharge: the length of stay and discharge destination was recorded. Results were analysed using standard statistical methods

Results: 122 patients were identified. 43 of the patients(35%) able to do their own shopping. There was a significant difference in length of stay between the two groups as well as mortality rate. Those able to do their own shopping stayed in hospital on average 4 days longer. In the group who could do their own shopping, 100% were discharged home from the trauma ward.

Conclusions: This study demonstrated that through the use of a single question it is possible to identify elderly patients suitable for home rehabilitation. All those patients who could do their own shopping were discharged home from the trauma ward without need for transfer to an in-patient rehabilitation ward. All patients who could do their own shopping were assessed as suitable for discharge home once they had completed a basic course of rehabilitation. This resulted in a longer length of stay in hospital. Identifying this group of patients it is possible to reduce their average length of stay in hospital from 14 days to 5 days. This is achieved using a fast track system for elective arthroplasty patients, based on a system of home rehabilitation. This results in improved care for the patients as well as financial savings on in-patient care.

Dislocation is the most frequent serious complication following total hip replacement for subcapital femoral fracture. We report a prospective study, using matched groups, which compared the range of hip movement following hip replacement for arthritis and for fracture. The range of movement was significantly greater in the fracture group. We suggest that this is a predisposing factor for dislocation.