Darwin Ang1, Jeffrey Anglen, Michele Ziglar, John Armstrong, Patrick Offner, Mark McKenney, David Plurad, Stephen Flaherty, Ernest Gonzalez, Huazhi Liu, Mary Danish, Gregory McCormack, Julie Nash, Roger Nagy, Matthew Carrick. 1. From the Ocala Health Trauma, Ocala Regional Medical Center (D.A., H.L.), Ocala, Florida; Department of Surgery, University of South Florida (D.A., J. Armstrong), Tampa, Florida; University of Central Florida, College of Medicine (D.A.), Orlando, Florida; Division of Orthopedic Surgery, Mcleod Regional Medical Center (J. Anglen), Florence, South Carolina; Trauma Clinical Services Group, Hospital Corporation of America (M.Z., M.D., G.M., J.N.), Nashville, Tennessee; Department of Trauma, Sky Ridge Medical Center (P.O.), Lone Tree, Colorado; Department of Trauma, Kendall Regional Medical Center (M.M.), Miami, Florida; Department of Trauma, Riverside Community Hospital (D.P.), Riverside, California; Department of Trauma, Del Sol Medical Center (S.F.), El Paso, Texas; Department of Trauma, South Austin Medical Center (E.G.), Austin, Texas; Department of Trauma, TriStar Skyline Medical Center (R.N.), Nashville, Tennessee; and Department of Trauma, Medical City (M.C.), Plano, Texas.
Abstract
INTRODUCTION: Isolated hip fractures (IHFs) in the elderly are high-frequency, life-altering events. Definitive surgery ≤24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery ≤24 hours was developed for a multihospital network. We report on its feasibility and subsequent patient outcomes. METHODS: This is a prospective multicenter cohort study, involving 85 levels 1, 2, 3, and 4 trauma centers. Patients with an IHF between 65 and 100 years old were studied. Four cohorts were examined: (1) hospitals that did not implement any PMG, (2) hospitals that used their own PMG, (3) hospitals that partially used the network IHF-PMG, and (4) hospitals that used the network's IHF-PMG. Multivariable logistic regression with reliability adjustment was used to calculate the expected value of observed to expected (O/E) mortality. Statistical significance was defined as p < 0.05. RESULTS: Data on 24,457 IHF were prospectively collected. Following implementation of the IHF-PMG, overall IHF O/E mortality ratios decreased within the hospital network, from 1.13 in 2017 to 0.87 in 2018 and 0.86 in 2019. Hospitals that developed their own IHF-PMG or used the enterprise-wide IHF-PMG had the lowest inpatient O/E mortality at 0.59 and 0.65, respectively. CONCLUSION: Goal-directed IHF-PMG for definitive surgery ≤24 hours was implemented across a large hospital network. The IHF-PMG was associated with lower inpatient mortality. LEVEL OF EVIDENCE: Therapeutic/ Care management, Level III.
INTRODUCTION: Isolated hip fractures (IHFs) in the elderly are high-frequency, life-altering events. Definitive surgery ≤24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery ≤24 hours was developed for a multihospital network. We report on its feasibility and subsequent patient outcomes. METHODS: This is a prospective multicenter cohort study, involving 85 levels 1, 2, 3, and 4 trauma centers. Patients with an IHF between 65 and 100 years old were studied. Four cohorts were examined: (1) hospitals that did not implement any PMG, (2) hospitals that used their own PMG, (3) hospitals that partially used the network IHF-PMG, and (4) hospitals that used the network's IHF-PMG. Multivariable logistic regression with reliability adjustment was used to calculate the expected value of observed to expected (O/E) mortality. Statistical significance was defined as p < 0.05. RESULTS: Data on 24,457 IHF were prospectively collected. Following implementation of the IHF-PMG, overall IHF O/E mortality ratios decreased within the hospital network, from 1.13 in 2017 to 0.87 in 2018 and 0.86 in 2019. Hospitals that developed their own IHF-PMG or used the enterprise-wide IHF-PMG had the lowest inpatient O/E mortality at 0.59 and 0.65, respectively. CONCLUSION: Goal-directed IHF-PMG for definitive surgery ≤24 hours was implemented across a large hospital network. The IHF-PMG was associated with lower inpatient mortality. LEVEL OF EVIDENCE: Therapeutic/ Care management, Level III.
Authors: Alirio J deMeireles; Laura Gerhardinger; Bryant W Oliphant; Peter C Jenkins; Anne H Cain-Nielsen; John W Scott; Mark R Hemmila; Naveen F Sangji Journal: Trauma Surg Acute Care Open Date: 2020-12-22
Authors: Molly P Jarman; Ginger Jin; Joel S Weissman; Arlene S Ash; Jennifer Tjia; Ali Salim; Adil Haider; Zara Cooper Journal: JAMA Netw Open Date: 2022-03-01