Quality improvement with implementation of a checklist for safe
discharge of hip fracture patients to nursing home
, M.I. Martinsen
, A. Rudolph
, A. Hægeland
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
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
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.
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
Poster presentations / European Geriatric Medicine 7S1 (2016) S29