LVN-led Transitional Care Coordinator Program for Hip Fractures Reduces Mortality

TL;DR

A program led by licensed vocational nurses to support hip fracture patients after surgery reduced their risk of death within 90 days and one year.

Contribution

This study demonstrates that an LVN-led transitional care coordinator program significantly reduces mortality in geriatric hip fracture patients.

Findings

The TCC program reduced 90-day mortality by 4.3 percentage points compared to the control group.

One-year mortality was also lower in the TCC group by 4.5 percentage points.

The program did not significantly affect ED visits or readmission rates.

Abstract

Hip fractures pose increased risk of morbidity and mortality in geriatric patients due to complex postoperative. This study analyzed the effects an LVN-led transitional care program had on outcomes of geriatric hip fracture patients in a large urban health system. A cross-sectional study with a non-randomized control group was performed from July 2018 to April 2024. An LVN was trained to be a transitional care coordinator (TCC) for the academic orthopaedic faculty, provided with postoperative protocols for pain, mobilization, DVT prophylaxis, and wound care following hip fracture surgery, and performed phone calls to patients at 7-, 14-, 30-, and 90-days post-discharge. The TCC either answered patient questions directly or escalated questions to the orthopaedist or PCP. The study and control groups included patients contacted by the TCC (TCC) and not contacted by the TCC (control). Bivariate analyses were conducted regarding 90-day ED visits, 90-day readmissions, 90-day mortality, and 1-year mortality. A total of 1569 patients underwent hip fracture care during the study period, 620 (39.5%) of which included TCC. The control and TCC group were similar in age (83.13±8.73 vs. 82.58±8.73 years, p = 0.182) and sex (67.0% vs. 71.1% female, p = 0.086). No differences were seen in 90-day ED visits between control and TCC (6.9% vs 8.7%, p = 0.175) or 90-day readmissions (23.7% vs.19.7%, p = 0.06). TCC had lower 90-day (7.8% vs. 3.5%, p = 0.001) and 1-year mortality rates (11.6% vs. 7.1%, p = 0.003). These findings highlight the benefits and importance of a TCC program as it reduced morality and potentially addressed gaps of post-discharge care.