Reengineering the Management of Patients with Hip Fracture in a Community Hospital Setting

1Mission Hospital, Asheville, NC
2Mission Hospital, Asheville, NC

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 181


Mission Hospital is a regional community hospital serving Ihe population of western North Carolina, We repair around 500 hip fractures per year in patients older than 65, more lhan any hospital in North Carolina which ranks third in the nation in incidence of hip fracture. Since 2006 the hospital has experienced increased costs and length of stay, and has had a net loss of revenue for this group of patients. There is evidence from other sites to indicate thatcollaboralion between orthopedists and hospitalists/geriatricians results in improved costs and outcomes. These studies have been conducted ir integrated systems and in academic centers with geriatricians on staff. Mission Hospital is servec by diverse groups of employed and private orthopedists and by a 26‐person group of private hospitalists. Reproducing results obtained from academic centers can be challenging in a community hospital setting.


Our goal was to show that improved and standardized collaboration between hospitalists and orthopedists could be achieved in this setting and would result in improved length of stay and revenue generation with no adverse effect on 30‐day readmission rates. Length of stay with and without hospilatist consult.


We started collecting data regarding hospitalist consultation, length of stay, cost of care, and door‐to‐operating time in 2006. We reviewed current literature and performed site visits at other facilities that have collaborative programs To evaluate best practices. We revised hip fracture order sets lo incorporate gerialric besl practices and obtained buy‐in from the hospital administration, orthopedic service line, hospitalists, and nursing staff. We undertook extensive nursing education on pain management in the geriatric population and on delirium preven‐lion and treatment. We continuously collected data on length of stay, cost of care, incidence QI delirium, door‐lo‐operating time, and 30‐day readmission rates. Starting with a 3‐month pilot, we used a rapid PDSA cycle to improve our process. By April 2009 we had finalized our order sets incorporating a geriatric pain management plan and measurement of vitamin D levels. We negotiated a dedicated hospitalist for rounding on hip fracture patients and standardized the consult process. Patients were broken into cohorts according to comorbidities (DRG 480^182).


Review of hospital data prior to the initiation of the project suggested that hip fracture patients followed by Ihe hospitalists had lower lengths of stay. This trend continued as the number of patients seen by hospitalists increased. Lengths of stay decreased in all comorbidity cohorts. The most striking decrease was in patients with major comorbidities. Net income per case changed from ‐$2000 to +S500, resulting in an annualized cost change from net ‐S1,000,000 to net +$250,000. There was no change in 30‐day readmission rates.

Author Disclosure:

C, McOuiston, John A Hartford Foundation, funding resource; Atlantic Philanthropies Foundation, funding resource, none.

To cite this abstract:

McQuiston C, Hoskyns M. Reengineering the Management of Patients with Hip Fracture in a Community Hospital Setting. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 181. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed April 7, 2020.

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