High Level Care patients with hip fractures – does discharge destination from acute care affect outcomes?

Ms Lara Anderson¹, Dr Lara Kimmel¹, Dr  Chris Moran¹, Associate Professor  Sue Liew¹

¹The Alfred Hospital, Prahran, Australia

Background:  Hospital presentations for management of hip fracture are increasing and a growing cohort are admitted from High Level Care (HLC).  Whilst international hip fracture guidelines highlight the importance of multidisciplinary rehabilitation post-operatively, the most appropriate setting for this is unknown.

Aim:  To determine the factors associated with discharge destination for patients from HLC who underwent hip fracture fixation, and to compare 12 month outcomes for those returning to HLC with those admitted to a Sub-Acute Facility (SAF).

Methods: A retrospective case series review of all patients from HLC admitted to The Alfred hospital, Melbourne, for fixation of hip fracture in 2014-2015 was undertaken. Data including demographic and hospital event details, length of stay (LOS), discharge destination and 12 month functional outcomes measured by the Glasgow Outcomes Score – Extended (GOS-E) were collected.

Results: Ninety patients from HLC were included, with 68 patients (75.6%) returning to HLC and 22 (24.2%) admitted to a SAF.  Those discharged to a SAF had an average LOS at this facility of 20.79 days (SD 8.02).  This group also had a longer acute LOS [7 days (IQR 5, 10), compared to 6 days (IQR 4,7.5) p value=0.02].  There was no difference between groups at 12 months in terms of mortality or function on the Glasgow Outcome Scale Extended (GOS-E), with 50% of all patients deceased at this time point and the other 50% reporting a poor functional outcome.

Discussion: Patients from HLC who underwent fixation of a hip fracture had poor 12 month functional outcomes and a high rate of mortality irrespective of discharge destination.  Given these results, future research should explore opportunities to provide structured multidisciplinary rehabilitation in the HLC environment.  Prospective economic modelling and a comprehensive suite of outcome measures to evaluate stakeholder satisfaction with such a model of care are essential.

Biography:

Lara is an orthopaedic physiotherapist at The Alfred Hospital in Melbourne, with an interest in elderly orthopaedic trauma and clinician education.  She is currently enrolled in postgraduate study in health professional education.