Risk Stratification, Triage, and Implementation of an Expedited Hip Fracture Treatment Protocol Is it Safe and...

The population of patients in the USA over the age of 65 is expected to significantly increase over the next 40 years. These patients are at increased risk for hip fractures and will pose a burden to providers in the near future. In order to provide high value care, providers will need to maintain positive outcomes, mitigate complications, and reduce overall cost burdens. This study was designed to investigate the safety and efficacy of a patient transfer protocol between a large academic medical center and a single specialty orthopaedic institution. The protocol was, in turn, designed to provide high value care to the patients by safely redirecting a large volume of patients to the single specialty institution.

Over one calendar year, data was prospectively gathered on all patients admitted to our academic center's ER with hip fractures. Patients were then triaged to high or low risk for transfer according to an established set of medical criteria. Patients deemed low risk for transfer were sent to our single specialty orthopaedic institution for management. Data capture and analysis were completed using MS Excel and SPSS, respectively.

Patients treated at the single specialty orthopaedic institution experienced shorter overall hospital stays and were more likely to be discharged to home than a rehabilitation facility (6.35 versus 8.79 days, p < 0.0001; 22% versus 4%, p = 0.49). There was no significant delay in time to surgery for patients that were transferred (65 versus 79 hours, p = 0.18).

The transfer protocol was both safe and effective for patients with hip fractures. Transferring patients for treatment at single specialty institutions has the potential to significantly reduce hospital stays and is more likely to result in discharge to home than a rehabilitation facility, thus successfully providing high value care to patients.