Effects of a Hospitalist Model on Elderly Patients With Hip Fracture

University of Wisconsin–Madison, Madison, Wisconsin, United States
Archives of Internal Medicine (Impact Factor: 17.33). 04/2005; 165(7):796-801. DOI: 10.1001/archinte.165.7.796
Source: PubMed

ABSTRACT Hospitalists' increased role in perioperative medicine allows for examination of their effects on surgical patients. This study examined the effects of a hospitalist service created to medically manage elderly patients with hip fracture.
During a 2-year historical cohort study of 466 patients 65 years or older admitted for surgical repair of hip fracture, we examined outcomes 1 year prior to and subsequent to the change from the standard to the hospitalist model.
The mean (SD) time to surgery (38 [47] vs 25 [53] hours; P<.001), time from surgery to dismissal (9 [8] vs 7 [5] days; P = .04), and length of stay (10.6 [9] vs 8.4 [6] days; P<.001) were shorter in the hospitalist group. Predictors of shorter time to surgery were care by the hospitalist group (P = .002), older age (P = .01), and fall as the mechanism of fracture (P<.001), while American Society of Anesthesia scores of 3 and 4 were associated with increased time to surgery (P<.001). Receiving care by the hospitalist group (P<.001) and diagnosis of delirium (P<.001) were associated with increased chance of earlier dismissal, while admission to the intensive care unit decreased this chance (P<.001). Diagnosis of delirium was more frequent in the hospitalist group (74 [32.2%] of 230 vs 42 [17.8%] of 236; P<.001). There were no differences in inpatient deaths or 30-day readmission rates.
In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

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Available from: Jeanne M Huddleston, Sep 29, 2015
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    • "The intrahospital mortality rate obtained in our study was slightly higher than that obtained in some previous studies (14,30) but was similar or even lower than those rates demonstrated in other studies (1,24,31). Finally, with regard to the quality of the medical care provided to patients with hip fracture, we believe that the low readmission rate in the current study, which was lower than those reported in previous studies (27,30,32), confirms the efficacy of our model. "
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    ABSTRACT: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.
    Clinics (São Paulo, Brazil) 06/2012; 67(6):547-56. DOI:10.6061/clinics/2012(06)02 · 1.19 Impact Factor
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    • "Over the past 15 years, the impact of internal medicine ward attending physician type (e.g., hospitalist vs. non-hospitalist) on health care and educational outcomes, and resident satisfaction with in-patient rotations has been evaluated [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. However, one critical element that has been studied incompletely to date is the structure of the medical ward team at teaching hospitals (i.e. "
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    ABSTRACT: The optimal structure of an internal medicine ward team at a teaching hospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents. Harbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff∶attending ratio of 5:1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3:1 and 2:1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared. Nine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams. Altering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes.
    PLoS ONE 04/2012; 7(4):e35576. DOI:10.1371/journal.pone.0035576 · 3.23 Impact Factor
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    • "Hospitalists may also improve the timeliness of emergency surgical care. In three studies where admission and preoperative assessments were conducted by hospitalists as opposed to a member of the surgical team, mean time to surgery was reduced by 35% to 50% [62,81,82]. Along with improvements in efficiency prior to surgery, overall lengths of stay for surgical patients comanaged by hospitalists were reduced in all studies [48,77,82-84], although none demonstrated associated reductions in costs [48,77]. "
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    BMC Medicine 05/2011; 9(1):58. DOI:10.1186/1741-7015-9-58 · 7.25 Impact Factor
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