32.
The physically best-fit hip fracture patients stay hospitalized due to
logistic problems
Henrik Palm, Pia Iheme Nielsen, Morten Tange Kristensen, Henrik Kehlet
Department of Orthopaedic Surgery Hvidovre University Hospital;
Department of Orthopaedic Surgery, Hvidovre University Hospital;
Department of Physiotherapy, Hvidovre University Hospital; Section of
Surgical Pathophysiology, Rigshospitalet
Background:
Length of hospital stay following hip fracture surgery has,
depending on discharge destinations, been reduced to 1-2 weeks in fast-track
setups with standardized treatment and functional discharge criteria. Little is
however known about the specific reasons for why hip fracture patients are not
discharged earlier.
Purpose / Aim of Study:
To investigate the reasons for continued
hospitalization after 5 days in our standardized fast track hip fracture unit.
Materials and Methods:
125
consecutive patients (mean age: 79, gender:
86
F/39M) admitted from their own home with a hip fracture from Dec 2011 to
April 2012 and hospitalized 5 days after surgery, were included. Discharge
criteria were medically stabile with mobilization ability to independently get
in/out of bed and a chair, go to the toilet and walk with/without walking aid.
Staff members prospectively assessed reasons for continued hospitalization
once a day.
Findings / Results:
The mean length of stay was 12 days (range 5-27), with
61%
discharged back to own home, 5% to nursery home, 18% to other
departments and 14% to rehabilitation facilities. 2% died before discharge.
96%
fulfilled the mobilization discharge criteria prior to admission and 59%
achieved this again during hospitalization. Among these best-fit patients, the
mean length of stay after achievement was 3 days, with 32% of time used for
medical treatment, 6% for wound problems, 2% for staircase training and 7%
on patients unmotivated or afraid to go home, 30% on hospital delay, 4% on
community delay and 19% due to the fact that patients are seldom discharged
in weekends.
Conclusions:
The physically best-fit hip fracture patients, who are admitted
from their own home and achieve the discharge criteria of independent
mobilization during hospitalization, could be discharged earlier, if logistic
problems are taken care of.
