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


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
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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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