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

Abstract

Background: 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.

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

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

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

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

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

Measurements: 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.

Results: 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).

Conclusion: 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.