Healthcare News & Insights

Hospitals try new strategy for hip fractures

Traditionally, hip fractures were seen as less critical injuries for patients, and hospitals would push surgeries back several days. The logic was this gave patients time to prepare for the procedure. But due to research, this opinion is slowly changing, and many facilities are trying a different approach that has improved patient outcomes.  

gettyimages-185093448Hip fractures affect about 340,000 people each year, according to an article in the Wall Street Journal.

Many of these patients are older, and they also have conditions such as high blood pressure.

Another reason doctors often delayed hip surgery for patients with fractures was to make sure their other health problems were stable before the procedure. In the past, this was thought to improve patient outcomes post-surgery.

New research proves this may not be the best bet, though. A study published in the Journal of Orthopaedic Trauma looked at the outcomes for over 2 million people who had hip surgery.

Researchers found that, for every day the surgery was delayed, patients were more likely to suffer complications. And patients who had hip surgeries that took place two or three days after admission had higher mortality rates.

According to Dr. Joseph Zuckerman, one of the authors of the study, it’s likely patients’ decline was directly attributed to the effects of the surgery itself.

Dr. Philip Devereaux, cardiologist, said untreated fractures cause inflammatory responses in the heart and immune system that inhibit recovery post-surgery.

Success in boosting outcomes

To solve these problems, hospitals are treating hip fractures as more serious events. Instead of having patients wait for hip surgery, facilities are scheduling the procedures immediately, within a day or two after the injury occurred.

One hospital that’s taken this approach is St. Francis Hospital in South Carolina. Previously, St. Francis treated hip fracture patients as non-urgent cases. If a person came to the emergency department after a hip fracture, they’d wait hours to be seen – and wouldn’t have their surgery until close to three days later.

Even worse: Elderly patients would be given strong drugs to manage their pain, and the medications contributed to the development of issues that extended their hospital stay, such as postoperative delirium.

To solve this problem, St. Francis created a special fracture program that’s devoted specifically to hip fractures in older patients.

When the fracture care team learns a patient’s being transported to the hospital for a hip fracture, they work with EMTs right away to make sure patients aren’t given too many medications and fluids before the person makes it to the ED.

Once fracture patients arrive at the ED, they’re triaged as soon as possible. In fact, the wait time for hip fracture patients has decreased by half since St. Francis created the program. Plus, most patients are in surgery within hours instead of days.

Coordination of care has also improved. The fracture team works with rehabilitation programs to ensure patients receive the appropriate follow-up treatments after discharge, including physical therapy. The team also educates patients on nutrition and fall prevention so they won’t end up back in the hospital again.

These changes have dramatically improved outcomes. In eight years, the average length of stay for hip fracture patients went from more than eight days to less than four days. Only 10% of patients experience postoperative delirium (down from almost 80%), and mortality rates are less than 18% one year after the procedure.

Another bonus: Patient satisfaction scores have improved.

Widespread benefits

Because hip fractures are so common, facilities may want to take a page from St. Francis Hospital’s book and change how they handle these surgeries.

Tweaking your hospital’s approach to could lead to significant improvements in patient outcomes, which is crucial to survival as value-based care (complete with bundled payments) becomes the norm. Plus, any strategy that improves patients’ recovery while boosting satisfaction scores is worth a try.

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