Hip Fracture Redesign Project
Hip fractures from simple falls in the elderly represent a significant public health burden due to their frequency (3,866 admissions in BC in 2010/11; 3,885 in 2011/2012) and the expected growth of the aging segment of BC’s population. The societal impact affects resource utilization and management in both acute and long term health care sectors. Hip fracture events also affect individuals, with up to 30% dying in the year that follows and 50% losing one level of mobility and independence and they also impact funding as many require supervised housing. Estimates of first year cost of care range between $26,000 – $47,000 per fracture depending on the level of support required.
Simple measures such as early access to operative care and the involvement of ortho-geriatricians / internists as part of the multi-disciplinary team have proven effective in decreasing not only complications and mortality but have affected length of hospital stay and the need for Long Term Care. Supported by policy and health administrative changes, implementation of best practices can result in significant financial and quality of care impacts for the health system. Specifically, results from the UK experience indicate that of the first 200,000 patients tracked in the hip fracture database there was:
- A 15% reduction in mortality
- A 5% reduction in hospital stay
Placed in the context of hip fracture care in BC, where In-Hopsital LOS represents 66,300 bed-days annually, one could expect an efficiency gain of 3,300 bed-days to be saved or committed to other growing needs, along with the improved level of care and communication reported by jurisdictions which have committed to a best practice redesign.
This work specifically aims to i) review hip fracture care across the care continuum, ii) implement simple proven best practice measures in a pilot setting iii) measure the system’s performance at baseline and following implementation of best practices, and iv) assess the feasibility of expansion of these best practices on a Provincial scale.
Best Practice Tools
Provincial Order Sets