An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

Bracey, Daniel N.; Kiymaz, Tunc; Holst, David C.; Hamid, Kamran S.; Plate, Johannes F.; Summers, Erik C; Emory, Cynthia L.; Jinnah, Riyaz H.

doi:10.1177/2151458516661383

Cited by 39 publications

(26 citation statements)

References 28 publications

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“…To our knowledge, this is one of the largest studies evaluating the benefits of SCM over 5.8 years. Similar to our prior studies on this SCM model of care, 5,7 other studies have reported a decrease in medical complications, 8-10 LOS, [11][12][13] and cost of care 14 with SCM.…”

Section: Discussionsupporting

confidence: 86%

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Rohatgi

Weng

Ahuja

2020

Journal of Hospital Medicine

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Neurosurgery services in which the same Internal Medicine hospitalists are dedicated year round to each of these surgical services to proactively prevent and manage medical conditions. In this article, we evaluate if SCM was associated with continued improvement in patient outcomes between 2012 and 2018 in Orthopedic and Neurosurgery services at our institution. We conducted regression analysis on 26,380 discharges to assess yearly change in our outcomes. Since 2012, the odds of patients with ≥1 medical complication decreased by 3.8% per year (P = .01), the estimated length of stay decreased by 0.3 days per year (P < .0001), and the odds of rapid response team calls decreased by 12.2% per year (P = .001). Estimated average direct cost savings were $3,424 per discharge.

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Section: Discussionsupporting

confidence: 86%

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Rohatgi

Weng

Ahuja

2020

Journal of Hospital Medicine

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“…The utility and success of such services is well-documented in the literature. 11 - 14 After implementation of an orthopedic-hospitalist comanagement service for patients who were traditionally admitted to the general medicine service, Bracey et al cites a reduction in length of stay by 1.6 days without an increase in 30-day readmission or mortality. This is consistent with the study by Phy et al who noted a reduction in length of stay from 10.6 to 8.4 days and a reduction in time to surgery from 38 to 25 hours under a similar coordination initiaitive.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the study by Phy et al who noted a reduction in length of stay from 10.6 to 8.4 days and a reduction in time to surgery from 38 to 25 hours under a similar coordination initiaitive. 12 , 13 For institutions that do not have the resources to develop such comanagement programs, this analysis suggests that increased resources and attention should be devoted to discharge planning for hip fracture patients admitted to the medicine service. This could be either through the use of social work or clinical care coordinators.…”

Section: Discussionmentioning

confidence: 99%

Admitting Service Affects Cost and Length of Stay of Hip Fracture Patients

Lott

Haglin

Belayneh

et al. 2018

Geriatr Orthop Surg Rehabil

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Introduction:The purpose of this study was to analyze the effect of the admitting service on cost of care for hip fracture patients by comparing the cost difference between patients admitted to the medicine service versus those admitted to a surgical service.Methods:A 2-year cohort of patients 55 years or older who were admitted to a single level 1 trauma center with an operative hip fracture were included. Patient demographics, comorbidities, admitting service, complications, and hospital length of stay were recorded for each patient. Cost of hospitalization, discharge disposition, and 30-day readmissions were collected. Patients who were admitted to the medicine service (medicine cohort) were compared to those admitted to a surgery service (surgery cohort). Multivariate regression models controlling for age, Charlson comorbidity index (CCI), and American Society of Anesthesiology (ASA) scores were used to evaluate hospitalization costs with a P value of <.05 as significant.Results:Two hundred twenty-five hip fracture patients were included; 143 (63.6%) patients were admitted to a surgical service, while 82 (36.4%) were admitted to the medicine service. Patients admitted to medicine service had greater CCI and ASA scores, longer lengths of stay, and more complications than those patients admitted to surgery service. Linear regression model controlling for age, CCI, ASA score, and time to surgery demonstrates that patients admitted to a surgical service will have 2.0-day (95% confidence interval [CI]: 0.561-3.503; P = .007) shorter admissions with a US$4215 reduction in cost (95% CI: US$314-US$8116; P = .034) compared to patients admitted to the medicine service.Discussions:In our urban safety net hospital, hip fracture patients admitted to medicine service had longer lengths of stay and higher total hospitalization costs than patients who were admitted to surgery service.Conclusions:This study highlights that the admitting service should be an area of focus for hospitals when developing programs to provide effective and cost-conscious care to hip fracture patients.

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“…Implementation of a FLS has been shown to be costeffective [24] and associated with improved rates of osteoporosis treatment [25][26][27][28], secondary fracture [29,30] and mortality [30]. Patients with hip fracture are increasingly comanaged by hospitalist physicians [31][32][33][34]. While FLS have been deployed in a number of settings, we are unaware of prior studies describing a FLS in a hospitalist comanagement setting for patients with hip fracture.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a fracture liaison service for patients with hip fracture cared for on a hospital medicine service

et al. 2020

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Objective: Hip fracture is a common and morbid condition. Prior studies have shown that the majority of patients with fragility fracture are not treated for underlying osteoporosis. Our hospitalist-led co-management service for patients with acute hip fracture had no system for evaluating and treating osteoporosis in this cohort. Our objective was to implement a fracture liaison service (FLS) to assist patients with acute hip fracture and assess subsequent impact on diagnosis and treatment of osteoporosis. Methods: We conducted a pre-post study design at our tertiary academic center, including patients >50 years old hospitalized with acute hip fracture. We implemented a FLS, whereby all patients received endocrinology consultation. Outcome measures included the proportion of patients evaluated for osteoporosis by time of hospital discharge, comparing pre-implementation (12 months) and post-implementation (9 months) cohorts. We also measured the proportions of patients evaluated for and offered treatment for osteoporosis within 3 months of discharge for patients with post-discharge encounters visible in the medical record. Results: We identified 167 patients before and 124 after FLS implementation. In univariate analysis, the proportion of patients evaluated for osteoporosis before discharge increased from 0.6% to 72.6% (p < 0.001) pre-vs. post-implementation. The proportion of patients offered osteoporosis treatment within 3 months after discharge increased from 25.3% to 46.3% (p = 0.01). In multivariate analysis, post-implementation patients had higher odds of osteoporosis evaluation while hospitalized (OR = 470.4, p < 0.001) and higher odds of being offered osteoporosis treatment within 3 months (OR = 2.8, p = 0.008). Conclusions: Establishment of an FLS partnered with a hospitalist-led co-management service for patients with hip fracture was associated with significant improvements in the proportions of patients evaluated and offered treatment for osteoporosis. Wider adoption of this model has the potential to improve care for patients with hip fracture by narrowing the osteoporosis treatment gap.

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An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

Cited by 39 publications

References 28 publications

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Admitting Service Affects Cost and Length of Stay of Hip Fracture Patients

Implementation of a fracture liaison service for patients with hip fracture cared for on a hospital medicine service

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