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Quality improvement with implementation of a checklist for safe

discharge of hip fracture patients to nursing home

A.H. Ranhoff


, M.I. Martinsen


, A. Rudolph


, A. Hægeland



E.A. Sivertsen




Diakonhjemmet Hospital, Oslo,


Department of Clinical

Science, University of Bergen, Bergen, Norway


Patients living permanently in nursing homes (NH) are

frail, have comorbidities, often dementia, and have high 30-days

mortality after a hip fracture. They are often discharged back to the NH

short time after surgery. The objective was to implement a check-list

for safe discharge of these patients to improve their survival.


A quality study of NH-patients with 30-days follow up after

hospital stays for surgery of hip fracture from 01.01.2014 to 31.12.2015.

Data were obtained from a quality registry where information

are collected by an interdisciplinary team. Deaths within 30 days

after discharge from hospital was registered the year before and the

year after implementation of the checklist which included normal vital

signs, stable cardiovascular function, normal consciousness (Glasgow

Coma Scale >13), haemoglobin second postoperative day >8 g/dL,

surgical wound dry, no fever or ongoing intravenous antibiotic treat-

ment and acceptable fluid and nutrition intake.


After implementation of the checklist, 110 patients; 85 (77%)

women, mean age 89 (+/

7.4) compared with 119 patients in 2014; 82

(69%) women, mean age 88 (+/

7.2) in 2014, were discharged to NH.

Blood transfusions increased from 31 (26%) before to 40 (36%), p = 0.12,

after implementation. LOS increased from 2.8 (+/

1.8) to 3.8 (+/


days, and 30-days mortality decreased from 16 (13.4%) to 10 (9.1%),

p = 0.41.


After implementation of a checklist for safe discharge of

NH-patients after surgery for hip fracture, we had a trend of increased

number patients in need for blood transfusions, longer LOS, and

decrease in short-term mortality (non-significantly).


Predicting 1 year mortality in patients after repair of fractured

neck of femur (#NOF) using the Nottingham hip fracture score


S. Odedra, S. Naqvi, S. Sivasubramaniam.

Sandwell and West

Birmingham Hospitals (SWBH) NHS Trust, Birmingham, England


Surgical repair of fractured neck of femurs (#NOFs) is

associated with high post-operative mortality, poor functional

outcome and significant social costs. The accurate prediction of risk

pre-operatively is beneficial for several reasons

informed consent,

optimisation of co-morbidities and planning of clinical management.

The Nottingham Hip Fracture Score (NHFS) is a validated scoring

system which uses 7 pre-operative variables to estimate 30 day post-

operative mortality. We aimed to assess the validity of the NHFS to

predict 1 year mortality for a cohort of patients within the Sandwell

and West Birmingham Hospitals (SWBH) NHS Trust.


Mortality was retrospectively predicated by calculating the

NHFS of 100 patients over 65 who underwent surgical repair of #NOF

during December 2014

May 2015. Actual 1 year mortality data was

collected from the hospital NOF# database. Patients were risk stratified

as low risk (NHFS

4) and high risk (NHFS >5).


With a NHFS

4, average survival was 87.2%, compared

to predictions of 89.9% and with a NHFS Score of >4, average survival

was 73.8% compared to predications of 68.6%; i.e. predictions were

very close to the actual figures obtained. An awareness of NHFS scoring

has shown to improve survival rates, particularly in the high risk


Key conclusions:

The NHFS shows promising results for use as a

predictor of both 30 day and 1 year mortality following surgical repair

of #NOFs within the SWBH Trust. Pre-operative risk stratification is

valuable to the multi-disciplinary team to optimise care. Larger scale

studies will support this further.


Results of interdisciplinary approach in elective surgery for

colorectal cancer in geriatric patients: a case-control study

J. Llabata Broseta, F.J. Tarazona-Santabalbina, A. Belenguer Varea,

D. Cuesta Peredó, J.A. Avellana Zaragoza.

Geriatric Medicine

Department, Hospital Universitario de la Ribera


Population aging is generating an increase of hospital

surgical activity in geriatric patients. Given the functional, cognitive,

social and clinical profile of these patients, geriatric assessment in the

context of an interdisciplinary approach it is spreading in these



To evaluate the possible improvement of hospital care

quality provided by an interdisciplinary team (geriatric medicine and

general surgery departments) in elective surgery for colorectal cancer.


A case-control study in patients over 69 admitted for

surgery recruited between 2007 and 2012. Case was defined as the

patient treated with an interdisciplinary approach and control as

patient followed by general surgery staff.


The sample was composed of 320 patients (206 cases and 114

controls) with a mean age of 77 (SD = 4.99) years,199 (62.2%) men. The

cases presented a significant reduction in the odds ratio (OR) of

incidence of delirium 0.19 (95% CI 0.15

0.52; p 0.001) and the OR of

geriatric syndrome incidence 0.17 (95% IC 016

0.56; p 0.001). There

was no difference in the length of stay. Cox regression showed no

significant difference in mortality between cases and controls (p =

0.41; 95% CI 0.65



Cases had a reduced risk of delirium and geriatric

syndromes during hospital admission without presenting longer

hospital stays neither higher mortality.


Pre-operative functional mobility as an independent determinant

of inpatient recovery of activities after total knee replacement in

three subsequent different timeframes and pathways: results from

a single-centre cohort study

G. van der Sluis, A. Goldbohm, J. Elings, R. Nijhuis, R. Bimmel,

R. Akkermans, T. Hoogeboom, N. vanMeeteren.

Nij Smellinghe Hospital,

University of Maastricht, Radbout University Nijmegen


Aim was to investigate whether preoperative functional

mobility is a determinant of delayed inpatient recovery of activities

(IRoA) after total knee replacement (TKR). A novelty to our approach is

that we investigated if the association depends on postoperative

circumstances and provided care in three time periods that coincided

with clinical pathway changes.


A total of 682 patients scheduled for TKR in a regional

hospital between 2009 and 2015, were screened in their functional

mobility by the Timed up and Go (TUG) and De Morton mobility

index (DEMMI). The cut-off point for delayed IRoA was set on the

day that 70% of the patients were recovered, according to the

Modified Iowa Levels of Assistance Scale (MILAS) (a 5-item activity

scale). In a multivariable logistic regression analysis, we added either

the TUG or the DEMMI to a reference model including predic-

tors known from the literature. Moreover we investigated whether

three time period, that coincided with clinical pathway changes,

modified the association between functional mobility and IROA by

using interaction statistics.


TUG score (OR 1.10, 95%-CI: 1.06

1.15) was a significant

determinant of delayed IROA in a model also including age, BMI,

ASA score and ISAR score. DEMMI score (OR 0.96, 95%-CI: 0.95


was also a significant determinant of delayed IRoA in a model with the

same covariates. These associations were not modified by the time

period in which the TKR took place.


Functional mobility test performances of patients in TUG

and DEMMI are independent and stable determinants of delayed IROA

after TKR.

Poster presentations / European Geriatric Medicine 7S1 (2016) S29