University of Twente Student Theses


Care for hip fractures! Improving hip fracture patient care

Janus, Sarah (2012) Care for hip fractures! Improving hip fracture patient care.

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Abstract:Problem: Due to aging of the population, early detection of frailty in hospitalized elderly and taking preventive measures to functional decline becomes more important. The primary aim of the present study was to investigate whether the implementation of the Safety Management System “Kwetsbare Ouderen” in April 2012 at the Isala clinics in Zwolle, The Netherlands, led to an improvement of the care process in hip fracture patients aged 70 and older in comparison with the situation in 2011. The secondary aim was to explore the patient and physician satisfaction in April 2012. Method: In a retrospective and prospective cohort, the effect of the Safety Management System was measured in patients with a hip fracture. Patients were included if they were aged 70 years and older, diagnosed with a hip fracture, admitted to the emergency ward where surgical intervention to restore the fractured hip was carried out. Exclusion criteria were a pathological hip fracture and bedridden status before admission. The outcomes before (February to May 2011 - group) and after (February to April 2012 – group) implementation were compared. The primary outcome measure was the length of hospitalization. Secondary outcome measures included the number of geriatric consultations, delirium, in-hospital deaths, consultations, surgery within 24 hours, postoperative complications and accommodation (post). All hospital related information is extracted from the patient files. Potential participants for the patient satisfaction questionnaire were eligible if they spoke Dutch and did not have dementia or a delirium. Physicians working at the surgical, orthopaedic or geriatric internal department were interviewed about their satisfaction. Satisfaction was measured in April 2012. Results: The 2011-group consisted of 80 patients; the 2012-group consisted of 70 patients. Mean length of stay decreased with 1.1 days from 9.4 days in the 2011-group to 8.3 days in the 2012-group. Preoperative consultations of a geriatric occurred only once in the 2011-group (1%) compared to 14 out of 70 (20%) in 2012. Postoperative geriatric consultations did not change. Delirium did not change between the two groups. In the 2011-group 88% (N=70) had surgery within 24 hours and in the 2012-group only 76% (N=53) had surgery within 24 hours. In 2012 more minor complications were related to surgery (9% more), but less severe complications related to the general health of the patient (8% less). There were minor differences in the number of consultations of other specialists (geriatric consultations excluded). In 2011 16% less internal consultations were requested. There was also an increase in consultation requests for specialists who form the group “other” (14% more). Change in accommodation did not differ much between the two years. In 2011 the patients generated about € 200 more costs than the patients in 2012. Due to the significance of the length of stay in this research it was decided to identify predictors of the length of stay. The length of stay was related to gender, complications, repair type, surgery within 24 hours and previous accommodation. The results from the patient satisfaction questionnaires showed that patients were highly satisfied with the care they received at the clinics. Patients evaluated quality of care provided by nurses, physicians and the overall quality of care as positive. Most physicians rate the quality of care only as reasonable and recommend more involvement of the internal department. The interviews with the physicians and the physician assistant reveal points of improvement for the treatment of hip fracture patients. All but one physician supported the idea of a co-managed treatment concept. iii Discussion: The results of the study suggest that the implementation of the Safety Management System led to a minor improvement in the care process of elderly patients with a hip fracture. Since the implementation of the program, the length of stay slightly decreased and the percentage of preoperative geriatric consultations slightly increased. However, one should look at the impact of the program after some time has elapsed. A different approach, such as the co-managed treatment concept, might be necessary to increase the number in preoperative geriatric consultations. Providing extra care only for the frail and elderly might not be enough to reduce the length of stay with three days as expected.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:88 social and public administration
Programme:Health Sciences MSc (66851)
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