Continuity, assessment and feedback in orthopaedic nursing care practice is cost-effective

Hip fracture treatment and rehabilitation are often considered as separate issues and generally performed in different locations. The rapidly increasing proportion of patients that is old and very old now calls for a new approach. This is a prospective study of 909 consecutive hip fracture patients, over 64 years old, admitted to hospital from an independent living situation. In a specialized hip fracture unit, 256 patients were given an early and intense rehabilitation program. It focused on continuity, feedback, reorientation and continuous monitoring of cognitive function and activities of daily living (ADL). Eighty-five percent of the patients could return directly to their own home after the initial treatment period. The mean total utilization of health care resources during the first 4 months after the injury was lower (28 institutional days) than in 286 historical controls given conventional rehabilitation (39 days, p < 0.05). At 4 months, 81% of the patients still lived in their own home vs. 72% of the controls and the 1-year mortality was 14% (21% in the controls, p < 0.05). After the project had been completed 297 patients formed an additional control group. In this group the proportion discharged to their own home decreased to 44% and the number of bed-days during the first 4 months returned to the pre-study level (39 days). It thus appears to be cost-effective to allocate sufficient rehabilitation resources early in the treatment of elderly patients with hip fractures. Annual savings in the catchment area due to the intervention were calculated to approximately 5,000,000 SEK. Continuous assessment and adequate continuity gives the staff emotional feedback, which promotes their personal commitment.