Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study - 29/03/25
, Yasna Barrera Fernández d, Rayén Delgado Gac e, Ada Carrillo f, Gedeón Lazcano Améstica g, Daniel Ulloa Vásquez g, Fernando Aranda h, Andrés Canales Pizarro i, Graciela Mardones h, Constanza Morales Gherardelli j, Victoria Assael Novik k, Osvaldo Sepúlveda g, Jossie Acuña l, Carola Arancibia Aravena h, Julio Ibarra i, Jack Bell m, Emma Sutton n
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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.
Le texte complet de cet article est disponible en PDF.Keywords : Hip fractures, Orthogeriatrics, Health policy, Quality management, Protocol
List of abbreviations : HFx, DGFH, VQHS, TTS, TGH, TSH, TIHT
Plan
| Note: An abstract of this paper won the first place in oral modality of scientific works presented during the XXVI National Congress of Geriatrics of the Society of Geriatrics and Gerontology of Chile. |
Vol 14 - N° 3
Article 100014- juin 2025 Retour au numéro
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