Introduction:Hip fracture remains the biggest single source of morbidity and mortality in the elderly trauma population, and any intervention focused on quality improvement and system efficiency is beneficial for both patients and clinicians. Two of the variables contributory to improving care and efficiency are time to theater and length of stay, with the overall goal being to improve care as reflected within the achievement of best practice tariff. One of the biggest barriers to optimizing these variables is preinjury anticoagulation.Method:Building on our previous work with warfarin in this population, we utilized a regional hip fracture collaborative network collecting prospective data through the National Hip Fracture Database with custom fields pertaining to all agents, including novel oral anticoagulants.Results:In all, 1965 hip fracture patients median age 83 years (1639 not anticoagulated) were admitted to the 5 centers over 12 months. Median length of stay was 20.71 days; time to theater 23.09 hours, and the populations (anticoagulated vs control) were evenly matched for injury. Anticoagulated patients were delayed to theater (P ≤ .001), were inpatients for longer (P ≤ .001) and gained less best practice tariff (P ≤ .05). All variables per agent were noted and the impact of each assessed.Conclusions:Despite the widespread use of newer anticoagulants, popular due to unmonitored reversal and administration, patients stay longer in hospital and wait longer for surgery than nonanticoagulated patients of the same age and injury. Contemporary perioperative practices impact negatively on the ability to perform timely surgery on hip fracture patients. We propose a guideline specific to the management of anticoagulation in the hip fracture population to aid the optimum preparation of patients for theater, achievement of timely surgery, and potentially reduce length of stay.

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Introduction: Therapy sessions that do not result in treatment (nontreatment) occur in 15% to 26% of scheduled sessions. The relationship between therapist personality and nontreatment is unknown. Objective: To determine the relationship between physical therapist personality and nontreatment events in the acute hospital. Methods: The relationship between physical therapist personality (Big Five Inventory) and nontreatment was statistically modeled adjusting for other therapist and patient factors. Results: There were 522 patients and 34 physical therapists with 918 scheduled physical therapy sessions included. The average age of patients was 71 (SD = 16, range = 17-99) and 41 (SD = 7, range 27-54) for therapists. Therapists with higher openness had lower nontreatment, odds ratio 0.93; 95% confidence interval 0.87 to 0.99; P = .045. Conclusions: The positive effect of physical therapy is minimized when scheduled treatment does not occur. Lower nontreatment is associated with more trait openness. Attributes related to openness (eg, inquisitiveness and problem-solving) should be cultivated. More research is needed to understand nontreatment and guide therapists in hospital patient care.

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