Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England

Neuburger, Jenny; Currie, Colin; Wakeman, R.; Johansen, Antony; Tsang, Carmen; Plant, F; Wilson, Helen W.; Cromwell, David; Meulen, Jan van der; Stavola, Bianca De

doi:10.1093/ageing/afw201

Cited by 32 publications

(31 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Now only 78% of the patients above 70 receive orthogeriatric management during admission, which is low compared to the 2016 NHFD in which 89% of the patients above 60 years of age received orthogeriatric management [ 4 ]. A study with NHFD data also demonstrated that an increase of orthogeriatric treatment hours per patient was associated with a 3.4% relative risk reduction of mortality [ 38 ]. In the DHFA, only 23% of the patients is treated on a special ward with high orthogeriatrician hours per patient.…”

Section: Discussionmentioning

confidence: 99%

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Voeten

Arends²,

Wouters

et al. 2019

Arch Osteoporos

View full text Add to dashboard Cite

Summary The nationwide Dutch Hip Fracture Audit (DHFA) is initiated to improve the quality of hip fracture care by providing insight into the actual quality of hip fracture care in daily practice. The baseline results demonstrate variance in practice, providing potential starting points to improve the quality of care. Purpose The aim of this study is to describe the development and initiation of the DHFA. The secondary aim is to describe the hip fracture care in the Netherlands at the start of the audit and to assess whether there are differences in processes at baseline between hospitals. Methods Eighty-one hospitals were asked to register their consecutive hip fracture patients since April 2016. In 2017, the first full calendar year, the case ascertainment was determined at audit level. Three quality indicators were used to describe and assess the care process at audit and hospital level: the proportion of completed variables at discharge and at 3 months after operation, time to surgery and orthogeriatric management. Results Sixty (74%) hospitals documented 14,274 patients in the DHFA by December 2017. In 2017, the case ascertainment was 58% and the average proportion of completed variables was 77%: 91% at discharge and 30% at 3 months. The median time to operation was 18 h (IQR 7–23) for American Society of Anesthesiologists score (ASA) 1–2 patients and 21 h (IQR 13–27) for ASA 3–4 patients. Of patients aged 70 years and older, 78% received orthogeriatric management. At hospital level, all three indicators showed significant practice variance. Conclusion Not all hospitals participate in the DHFA, and the data gathering process needs to be further optimized. However, the baseline results demonstrate an apparent variance in hip fracture practice between hospitals in the Netherlands, providing potential starting points to improve the quality of hip fracture care.

show abstract

Section: Discussionmentioning

confidence: 99%

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Voeten

Arends²,

Wouters

et al. 2019

Arch Osteoporos

View full text Add to dashboard Cite

show abstract

“…It is well recognised that comprehensive geriatric assessment is crucial in the management of patients with hip fractures 47. A higher number of orthogeriatrician contact hours per patient has been shown to reduce 30-day mortality from a fractured hip 48. Irrespective of specific injury, there is a high prevalence of cognitive impairment and polypharmacy among older trauma patients, and complications such as delirium and acute kidney injury are common 49.…”

Section: Where Should This Man Be Admitted?mentioning

confidence: 99%

Blunt chest trauma in the elderly: an expert practice review

et al. 2019

View full text Add to dashboard Cite

Trauma in the elderly (>65 years) is an increasingly common presentation to the ED. A fall from standing height is the most common mechanism after which such patients present, and rib fracture is the most common non-spinal fracture. Thoracic injury in patients aged over 65 is associated with significant morbidity and mortality. There are currently no universally applied guidelines for assessment, investigation and management of such patients. In this expert practice review, we discuss the evidence base and options for clinical management in this vulnerable patient group.

show abstract

“…62 Furthermore, the risk of in-hospital death depends on the length of time spent in hospital, which in turn depends on the presence (or absence) of early discharge policies. 3 The risk of death may also depend on where patients undergo treatment, 37,38 because of between-hospital differences in quality of care, 20 intensity of care, 63 clinical pathways, 42,64 and care standards. 20,65 [Insert Figure 1 and Table 1 here]…”

Section: Dependency Graphmentioning

confidence: 99%

“…Clinical pathways bring attention to hip fracture patients and their prioritization on operating room lists, which facilitates early access to surgery and is associated with better outcomes. 42,64 Clinical pathway Treatment in hospitals with lower care intensity leads to death. 63 Care intensity…”

Section: Structurementioning

confidence: 99%

Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

In hip fracture care, it is disputed whether mortality worsens when surgery is delayed. This knowledge gap matters when hospital managers seek to justify resource allocation for prioritizing access to one procedure over another. Uncertainty over the surgical timing-death association leads to either surgical prioritization without benefit or the underuse of expedited surgery when it could save lives. The discrepancy in previous findings results in part from differences between patients who happened to undergo surgery at different times. Such differences may produce the statistical association between surgical timing and death in the absence of a causal relationship. Previous observational studies attempted to adjust for structure, process, and patient factors that contribute to death, but not for relationships between structure and process factors, or between patient and process factors. In this article, we (1) summarize what is known about the factors that influence, directly or indirectly, both the timing of surgery and the occurrence of death; (2) construct a dependency graph of relationships among these factors based explicitly on the existing literature; (3) consider factors with a potential to induce covariation of time to surgery and the occurrence of death, directly or through the network of relationships, thereby explaining a putative surgical timing-death association; and (4) show how age, sex, dependent living, fracture type, hospital type, surgery type, and calendar period can influence both time to surgery and occurrence of death through chains of dependencies. We conclude by discussing how these results can inform the allocation of surgical capacity to prevent the avoidable adverse consequences of delaying hip fracture surgery.

show abstract

Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England

Abstract: in the context of initiatives to improve hip fracture care, we identified statistically significant and robust associations between increased orthogeriatrician hours per patient and reduced 30-day mortality.

Cited by 32 publications

References 12 publications

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Blunt chest trauma in the elderly: an expert practice review

Mortality by Timing of Hip Fracture Surgery

Contact Info

Product

Resources

About