Interdisciplinary Discharge Team Lowers Readmissions, May Reduce Mortality Following Hip Fracture
Nursing home residents with a hip fracture generally have a higher mortality rate than their community-dwelling counterparts. A key component of lowering mortality is to improve the management of post-operative complications and reduce readmissions. A new study in the April issue of JAMDA suggests that an interdisciplinary discharge program can lower readmission rates, improve quality of life, and possibly reduce mortality rates for hip fracture patients discharged to the nursing home.
In Standardized, Coordinated Care in Nursing Homes Lowers Rehospitalization After Hip Fracture, the researchers employed an intervention on one group consisting of a safety program for the first 14 days post-discharge and including assessment of vital signs, weight, pain, signs of constipation, hours of mobilization, and daily intake of fluids and high-protein beverages. A team of acute-care nurses undertook visits (planned and unplanned) and could take blood samples and administer intravenous fluids/antibiotics at the nursing facility. Control participants received usual care.
There were 100 patients in the intervention group and 152 in the control group. The 30-day readmission rate was 14% in the intervention group and 30% in the control group. The 30-day mortality rate was 6% in the intervention group and 13% in the control group. There was no statistically significant difference in mobility between the two groups, but there was a higher health-related quality of life score in the intervention group.
Close collaboration between the hospital, nursing home, and municipality when discharging patients is key, the authors suggested. This can be done, they said, by establishing simple post-discharge metrics and giving the nursing facility staff easy access to acute-care nurses as well as doctors.
The study was conducted by researchers at the Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Research, University of Southern Denmark, Odense, Denmark; and Department of Geriatrics Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.