The number of hip fracture admissions is rising; with reduced hospital bed capacity and increasing patient numbers, care pathways must be optimised to maximise inpatient bed efficiency. There is currently significant interest in improving healthcare services across all 7 days in the United Kingdom. It is unclear whether lack of allied healthcare professional review at the weekend is detrimental to hip fracture patient care. This study aims to examine whether providing 7-day physiotherapy and occupational therapy (7DPOT) service improves outcomes for fractured neck of femur patients compared to a 5-day service (5DPOT). All patients admitted with an acute neck of femur fracture were grouped into three cohorts, depending on provision of 7DPOT services: the initial cohort received 5DPOT between December 2012 and March 2013. Seven-day physiotherapy and occupational therapy was introduced for one year from October 2014 until September 2015 (2nd cohort). The service then reverted to 5DPOT between January to June 2016 (3rd cohort). The third cohort was utilised to nullify changes in the overall service which had occurred which were not attributable to 7DPOT. Data was collected prospectively using a specially designed audit tool.Introduction
Methods
The availability of seven-day NHS services for patients is currently receiving widespread national attention. Rehabilitation services including physiotherapy and occupational therapy are not routinely available at the weekend. The aim of this pilot study was to determine if seven-day rehabilitation services led to improved outcomes for hip fracture patients. All proximal femur fractures were included and formed into two cohorts. Data were collected prospectively in each cohort. Cohort one underwent standard five-day rehabilitation (n=79). Cohort two received seven-day rehabilitation (n=338). Both groups were followed up to 120 days. No significant differences were observed between the cohorts for pre-fracture place of residence, ASA score or age. Combined median length-of-stay in hospital and rehabilitation improved from 28 to 21 days (p=0.054) Combined median length of stay for patients admitted from home improved from 26 to 19 days (p=0.016). This pilot study suggests that a seven-day physiotherapy and occupational therapy service may result in decreased total length-of-stay in hospital and subsequent rehabilitation. This is a clear benefit for our patients but also for our hospitals and rehabilitation units where beds are at such a premium. A wider study across multiple institutions within NHS Scotland is now needed to investigate this further.
