Jackson Kelly, Bachhuber Mary, Bowden Dawn, Etter Katherine, Tong Cindy
Neuroscience Service Line, HonorHealth Osborn Medical Campus Administration, HonorHealth System, Scottsdale, AZ, USA.
Orthopedics, HonorHealth System, Scottsdale, AZ, USA.
Geriatr Orthop Surg Rehabil. 2019 May 15;10:2151459319846057. doi: 10.1177/2151459319846057. eCollection 2019.
Hip fractures are common and costly in the elderly population, often contributing to loss of function and independence. Prompt, coordinated surgical care may improve clinical and economic outcomes for this population.
We created an interdisciplinary care program focused on minimizing time spent immobilized awaiting surgery and streamlining the care pathway for hip fracture. Patients older than 65 years with any hip fracture type including hip fracture repair Diagnosis-Related Group codes (MS-DRG 480, 481, or 482) and MS-DRG 469 and 470 with a hip fracture diagnosis were included in the study. The Hip Fracture Care program (HFCP) was implemented on a staggered basis in 3 hospitals in the HonorHealth system. Time to surgery, length of stay, and discharge location (home/skilled nursing facility) were compared pre- and post-intervention, utilizing an interrupted time series analysis to account for background trends.
More than 2000 patients across the 3 facilities received HFCP care; demographics were similar for the 826 patients serving as the pre-implementation comparison group. Mean (standard deviation [SD]) length of stay decreased from 5.6 (4.0) to 4.7 (2.9) days (mean difference 0.9 days; < .05). Mean (SD) time from admission to the operating room decreased from 30.8 (21.1) to 25.6 (20.5) hours (mean difference 5.2 hours; < .05). There was no change in the proportion of patients discharged to home versus skilled nursing facility.
Optimal care of this vulnerable population can significantly reduce the time to surgery and length of stay.
Length of stay was reduced by nearly 1 day with implementation of a multifactorial program for hip fracture care.
髋部骨折在老年人群中很常见且代价高昂，常常导致功能丧失和生活不能自理。及时、协调的手术治疗可能会改善该人群的临床和经济结局。
我们创建了一个跨学科护理项目，重点是尽量减少等待手术时的固定时间，并简化髋部骨折的护理流程。纳入研究的患者为65岁以上的任何类型髋部骨折患者，包括髋部骨折修复诊断相关组代码（MS-DRG 480、481或482）以及诊断为髋部骨折的MS-DRG 469和470。髋部骨折护理项目（HFCP）在HonorHealth系统的3家医院分阶段实施。利用中断时间序列分析来考虑背景趋势，比较干预前后的手术时间、住院时间和出院地点（家庭/专业护理机构）。
3家机构的2000多名患者接受了HFCP护理；作为实施前比较组的826名患者的人口统计学特征相似。平均（标准差[SD]）住院时间从5.6（4.0）天降至4.7（2.9）天（平均差异0.9天；P<0.05）。从入院到手术室的平均（SD）时间从30.8（21.1）小时降至25.6（20.5）小时（平均差异5.2小时；P<0.05）。出院回家与出院到专业护理机构的患者比例没有变化。
对这一脆弱人群的最佳护理可显著缩短手术时间和住院时间。
实施多因素髋部骨折护理项目使住院时间缩短了近1天。
