Fergus Lucy, Cutfield Greer, Harris Roger
Older Peoples Health, Auckland City Hospital, New Zealand.
N Z Med J. 2011 Jun 24;124(1337):40-54.
The process of care of older patients with fractured neck of femur at Auckland City Hospital has recently changed with selected patients "fast-tracked" as soon as possible postoperatively to a specialised Older People's Health (OPH) ward.
The aims of this study were: to evaluate patient characteristics; to analyse process of care; to compare outcomes in those "fast-tracked" patients with those receiving usual care; and to compare this information with previous data from Auckland City Hospital and other centres in New Zealand.
Prospective case record audit of patients with fractured neck of femur aged 65 years and over admitted under Orthopaedics over a 4-month period.
115 patients were audited; mean age was 84 years, 77% were female. Inpatient mortality was 5%. Twenty-four percent of patients had surgery within 24 hours of admission. Of those who did not have surgery within 24 hours, 39% were awaiting operating theatre availability. Median overall length of stay (LOS) was 27 days. Eighty-four percent of patients were transferred to Older Peoples Health. Considering all patients, 70% of those living at home pre-fracture returned home on discharge. However, only 26% of those in Rest Home returned to Rest Home. Overall, 35% of patients were discharged to a higher level of care. Forty-four percent of the group were able to walk unaided prior to hip fracture, but only 1% on discharge. Forty-three patients were "fast-tracked" to Older Peoples Health. Their median overall LOS was 23 days compared to 28 days for those receiving usual care. This was due to the shorter time in Orthopaedics. Thirty-three percent of this group went to a higher level of care on discharge compared to 35% in the group that received usual care.
Many patients experience a delay to surgery for non-medical reasons. The percentage transferred to Older Peoples Health is high. Fast-tracking to Older Peoples Health shortens overall length of stay due to fewer days in Orthopaedics. Many patients require a higher level of care after hip fracture, particularly if already resident in Rest Home. Demographics and inpatient mortality are comparable, but total length of stay is longer than similar New Zealand studies due to a longer length of stay in Older Peoples Health. Review of previous data from Auckland City Hospital and from other New Zealand centres shows significant variability in process of care for older patients with hip fracture.
奥克兰市医院对老年股骨颈骨折患者的护理流程最近有所改变，部分患者术后尽快被“快速通道”转至专门的老年人健康（OPH）病房。
本研究的目的是：评估患者特征；分析护理流程；比较“快速通道”患者与接受常规护理患者的结局；并将这些信息与奥克兰市医院及新西兰其他中心的既往数据进行比较。
对4个月内骨科收治的65岁及以上股骨颈骨折患者进行前瞻性病例记录审核。
共审核了115例患者；平均年龄84岁，77%为女性。住院死亡率为5%。24%的患者在入院24小时内接受了手术。在24小时内未接受手术的患者中，39%在等待手术室可用。总体住院时间（LOS）中位数为27天。84%的患者被转至老年人健康病房。考虑所有患者，骨折前在家居住的患者中，70%出院时回家。然而，养老院患者中只有26%返回养老院。总体而言，35%的患者出院后转至更高水平的护理机构。该组中44%的患者在髋部骨折前能够独立行走，但出院时只有1%。43例患者被“快速通道”转至老年人健康病房。他们的总体LOS中位数为23天，而接受常规护理的患者为28天。这是由于在骨科的时间较短。该组中33%的患者出院后转至更高水平的护理机构，而接受常规护理的组为35%。
许多患者因非医疗原因手术延迟。转至老年人健康病房的比例较高。“快速通道”转至老年人健康病房可缩短总体住院时间，因为在骨科的天数较少。许多患者髋部骨折后需要更高水平的护理，尤其是如果他们已经住在养老院。人口统计学和住院死亡率具有可比性，但由于在老年人健康病房的住院时间较长，总住院时间比新西兰的类似研究更长。对奥克兰市医院和新西兰其他中心的既往数据进行回顾显示，老年髋部骨折患者的护理流程存在显著差异。
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