Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study

TL;DR

Immediate hospital admission for older patients with hip fractures reduces hospital transfers, surgery delays, and costs.

Contribution

A protocol for immediate surgical hospital admission significantly improves quality indicators for hip fracture management in older patients.

Findings

Immediate admission reduced inter-hospital transfers from 37.8% to 23.3%.

Time to surgery decreased from 15 to 10 bed days.

Total in-hospital time and costs dropped by 21% and from USD130,000 to USD35,000.

Abstract

Hip fractures generate high biomedical, social, functional, organisational, and economic costs. There are various quality indicators to guide its management. One of them is surgery within 48–72 h. In Chilean public health system, this indicator has out-of-standard results. This situation could have organizational causes: after hip fracture diagnosis, many older patients are first referred to general hospitals, whilst waiting an orthopedic surgical bed.

To evaluate the effects of a protocol of immediate-admission to the surgery hospital on organisational and economic indicators of hip-fractured older patients.

Before-and-after study, between 01/01/2017–09/30/2019; 12 months before and 21 months after implementation.

Regional surgical hospital responsible for 87 % of the older population in its assigned territory, in the more aged region of Chile.

Anonymised data of 902 hip-fractured older adults (≥ 60 years).

Implementation of a protocol that requires immediate admission to the surgical hospital of all older hip-fractured patients at the time of diagnosis.

Number of hip-fractured patients with no immediate admission, time to surgery, total in-hospital time, and economic costs. Normality tests (Kolmogorov-Smirnov), non-parametric tests (Chi-squared), Mann-Whitney and Kruskal-Wallis tests were performed. Measures of central tendency (medians and percentiles) were used.

After protocol there was a significant reduction in the proportion of patients referred to general hospitals in both, first and second year (pre=37,8 %; post 1 = 27,3 %; post 2 = 23,3 %, p = 0,000). Time to surgery was also significantly reduced (medians bed days pre=15, post 1 = 11, post 2 = 10, p = 0,000). Total in-hospital time decreased 21 % (3395 bed days), and there was also a significant decrease in costs from USD130,000 to USD35,000 (p = 0,000).

Immediate admission to orthopedic surgical hospital of older adults with hip fractures significantly decreases inter-hospital transfers, time to surgery, total in-hospital time, and direct hospital costs.

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