Baryeh Kwaku W, Elliott David, Harb Ziad, Lisk Radcliffe
Core Surgical Trainee, Department of Trauma and Orthopaedics, St Peter's Hospital, Ashford and St Peter's Hospital NHS Trust, Chertsey, Surrey KT16 0QA.
Consultant Trauma and Orthopaedic Surgeon, Department of Trauma and Orthopaedics, St Peter's Hospital, Ashford and St Peter's Hospital NHS Trust, Chertsey, Surrey.
Br J Hosp Med (Lond). 2018 Jan 2;79(1):41-43. doi: 10.12968/hmed.2018.79.1.41.
In the UK, more than 60 000 patients present with a fractured neck of femur each year. These patients represent a huge financial cost. This study looks at the 30-day readmissions and total length of hospital stay of patients presenting with a fractured neck of femur, as well as length of stay in non-hip fracture trauma patients, following the change to a daily consultant-led ward round.
A total of 200 records of patients with fractured neck of femur were reviewed with data collected retrospectively and prospectively following the introduction of the daily consultant-led ward round. Readmissions were classed as patients who spent a period of time admitted to hospital. Those who only attended an emergency unit were not included. Reasons for readmission and length of readmission were reviewed as were the initial and total length of stay. The authors also evaluated the length of stay in trauma patients (non-hip fracture emergency admissions) for a period of 6 months before and 4 months after the new working model was introduced.
With the new working pattern, there was a reduction in the length of stay in those readmitted (13 vs 8 days), and the total length of stay of readmitted patients was also considerably lower (23 vs 13 days). In non-hip fracture trauma patients, there was a reduction in length of stay (8 vs 6 days).
This study demonstrates that by adopting a daily orthopaedic consultant-led ward round, it is possible to reduce the length of stay for patients with a fractured neck of femur, both on initial and subsequent hospital admissions, as well reducing the length of stay for non-hip fracture trauma patients.
在英国，每年有超过6万名患者因股骨颈骨折前来就诊。这些患者带来了巨大的经济成本。本研究着眼于股骨颈骨折患者的30天再入院情况和住院总时长，以及非髋部骨折创伤患者在改为由顾问医生每日查房后的住院时长。
在引入由顾问医生每日查房后，回顾了200例股骨颈骨折患者的记录，数据为回顾性和前瞻性收集。再入院患者被定义为入院一段时间的患者。仅前往急诊科就诊的患者不包括在内。对再入院原因和再入院时长以及初次住院时长和总住院时长进行了审查。作者还评估了新工作模式引入前6个月和引入后4个月创伤患者（非髋部骨折急诊入院）的住院时长。
采用新的工作模式后，再入院患者的住院时长有所缩短（13天对8天），再入院患者的总住院时长也显著降低（23天对13天）。在非髋部骨折创伤患者中，住院时长也有所缩短（8天对6天）。
本研究表明，通过采用由骨科顾问医生每日查房的模式，有可能缩短股骨颈骨折患者初次及后续住院的时长，同时也能缩短非髋部骨折创伤患者的住院时长。
