Patients with hip fracture are generally elderly, have coronary artery disease (CAD) or risk factors for CAD, and require urgent surgery. Perioperative use of beta‐ers is associated with decrease cardiac mortality and morbidity. However, beta‐ers are underutilized in clinical practice.
To improve the use of perioperative beta‐ers in patients undergoing noncardiac surgery. We hypothesized that intensive educational efforts will improve the use of beta‐ers in appropriate patients.
We developed educational tools including clinical guidelines and clinical vignettes on perioperative use of beta‐ers to enhance residents' and physicians' understanding and awareness of the literature about beta‐ers and to provide them with practical tips about beta‐er use. An educational intervention was initiated in July 2003 with the goal of increasing use of beta‐ers up to 90% or more. We studied 481 patients who were admitted to the hospital from the emergency department with a fractured hip (DRG 79.35 and DRG 81.52) between January 2002 and December 2005 and then underwent urgent hip surgery. Demographic information on the patients, including age, sex, and comorbid conditions such as coronary artery disease, diabetes, hypertension, renal insufficiency, cerebrovascular accident, congestive heart failure, arrhythmias, chronic obstructive pulmonary disease/asthma, was collected retrospectively. Eligibility and contraindications for beta‐ers were assessed according to ACC/ AHA Guidelines.
Before the intervention (in 2002), 44% of the eligible patients received beta‐ers perioperatively. After the intervention there was gradual improvement in the frequency of perioperative use of beta‐ers to 53% in 2003, 75% in 2004, and 90% in 2005.
In this study we have demonstrated significant improvement in perioperative use of beta‐ers with education of providers. We believe that lack of awareness of providers may be a significant barrier to achieving quality indicator targets. A similar intervention may be helpful in improving other quality measures.
A. Roy, None.
To cite this abstract:Roy A. The Hospitalist: Improving Patient Care and Closing the Quality Gap in Patients with Hip Fracture. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 53. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/the-hospitalist-improving-patient-care-and-closing-the-quality-gap-in-patients-with-hip-fracture/. Accessed March 28, 2020.