Effects of a hospitalist model on elderly patients with hip fracture

Michael P. Phy, David J. Vanness, L. Joseph Melton, Kirsten Hall Long, Cathy D. Schleck, Dirk R. Larson, Paul M. Huddleston, Jeanne M. Huddleston

Research output: Contribution to journalArticle

130 Citations (Scopus)

Abstract

Background: Hospitalists' increased role in perioperative medicine allows for examination of their effects on surgical patients. This study examined the effects of a hospitalist service created to medically manage elderly patients with hip fracture. Methods: During a 2-year historical cohort study of 466 patients 65 years or older admitted for surgical repair of hip fracture, we examined outcomes 1 year prior to and subsequent to the change from the standard to the hospitalist model. Results: The mean (SD) time to surgery (38 [47] vs 25 [53] hours; P<.001), time from surgery to dismissal (9 [8] vs 7 [5] days; P = .04), and length of stay (10.6 [9] vs 8.4 [6] days; P<.001) were shorter in the hospitalist group. Predictors of shorter time to surgery were care by the hospitalist group (P=.002), older age (P=.01), and fall as the mechanism of fracture (P< .001), while American Society of Anesthesia scores of 3 and 4 were associated with increased time to surgery (P<.001). Receiving care by the hospitalist group (P<.001) and diagnosis of delirium (P<.001) were associated with increased chance of earlier dismissal, while admission to the intensive care unit decreased this chance (P<.001). Diagnosis of delirium was more frequent in the hospitalist group (74 [32.2%] of 230 vs 42 [17.8%] of 236;P<.001). There were no differences in inpatient deaths or 30-day readmission rates. Conclusion: In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

Original languageEnglish (US)
Pages (from-to)796-801
Number of pages6
JournalArchives of Internal Medicine
Volume165
Issue number7
DOIs
StatePublished - Apr 11 2005

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Hospitalists
Hip Fractures
Delirium
Inpatients
Length of Stay
Intensive Care Units
Cohort Studies
Anesthesia
Medicine

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Phy, M. P., Vanness, D. J., Melton, L. J., Long, K. H., Schleck, C. D., Larson, D. R., ... Huddleston, J. M. (2005). Effects of a hospitalist model on elderly patients with hip fracture. Archives of Internal Medicine, 165(7), 796-801. https://doi.org/10.1001/archinte.165.7.796

Effects of a hospitalist model on elderly patients with hip fracture. / Phy, Michael P.; Vanness, David J.; Melton, L. Joseph; Long, Kirsten Hall; Schleck, Cathy D.; Larson, Dirk R.; Huddleston, Paul M.; Huddleston, Jeanne M.

In: Archives of Internal Medicine, Vol. 165, No. 7, 11.04.2005, p. 796-801.

Research output: Contribution to journalArticle

Phy, MP, Vanness, DJ, Melton, LJ, Long, KH, Schleck, CD, Larson, DR, Huddleston, PM & Huddleston, JM 2005, 'Effects of a hospitalist model on elderly patients with hip fracture', Archives of Internal Medicine, vol. 165, no. 7, pp. 796-801. https://doi.org/10.1001/archinte.165.7.796
Phy MP, Vanness DJ, Melton LJ, Long KH, Schleck CD, Larson DR et al. Effects of a hospitalist model on elderly patients with hip fracture. Archives of Internal Medicine. 2005 Apr 11;165(7):796-801. https://doi.org/10.1001/archinte.165.7.796
Phy, Michael P. ; Vanness, David J. ; Melton, L. Joseph ; Long, Kirsten Hall ; Schleck, Cathy D. ; Larson, Dirk R. ; Huddleston, Paul M. ; Huddleston, Jeanne M. / Effects of a hospitalist model on elderly patients with hip fracture. In: Archives of Internal Medicine. 2005 ; Vol. 165, No. 7. pp. 796-801.
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abstract = "Background: Hospitalists' increased role in perioperative medicine allows for examination of their effects on surgical patients. This study examined the effects of a hospitalist service created to medically manage elderly patients with hip fracture. Methods: During a 2-year historical cohort study of 466 patients 65 years or older admitted for surgical repair of hip fracture, we examined outcomes 1 year prior to and subsequent to the change from the standard to the hospitalist model. Results: The mean (SD) time to surgery (38 [47] vs 25 [53] hours; P<.001), time from surgery to dismissal (9 [8] vs 7 [5] days; P = .04), and length of stay (10.6 [9] vs 8.4 [6] days; P<.001) were shorter in the hospitalist group. Predictors of shorter time to surgery were care by the hospitalist group (P=.002), older age (P=.01), and fall as the mechanism of fracture (P< .001), while American Society of Anesthesia scores of 3 and 4 were associated with increased time to surgery (P<.001). Receiving care by the hospitalist group (P<.001) and diagnosis of delirium (P<.001) were associated with increased chance of earlier dismissal, while admission to the intensive care unit decreased this chance (P<.001). Diagnosis of delirium was more frequent in the hospitalist group (74 [32.2{\%}] of 230 vs 42 [17.8{\%}] of 236;P<.001). There were no differences in inpatient deaths or 30-day readmission rates. Conclusion: In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.",
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AB - Background: Hospitalists' increased role in perioperative medicine allows for examination of their effects on surgical patients. This study examined the effects of a hospitalist service created to medically manage elderly patients with hip fracture. Methods: During a 2-year historical cohort study of 466 patients 65 years or older admitted for surgical repair of hip fracture, we examined outcomes 1 year prior to and subsequent to the change from the standard to the hospitalist model. Results: The mean (SD) time to surgery (38 [47] vs 25 [53] hours; P<.001), time from surgery to dismissal (9 [8] vs 7 [5] days; P = .04), and length of stay (10.6 [9] vs 8.4 [6] days; P<.001) were shorter in the hospitalist group. Predictors of shorter time to surgery were care by the hospitalist group (P=.002), older age (P=.01), and fall as the mechanism of fracture (P< .001), while American Society of Anesthesia scores of 3 and 4 were associated with increased time to surgery (P<.001). Receiving care by the hospitalist group (P<.001) and diagnosis of delirium (P<.001) were associated with increased chance of earlier dismissal, while admission to the intensive care unit decreased this chance (P<.001). Diagnosis of delirium was more frequent in the hospitalist group (74 [32.2%] of 230 vs 42 [17.8%] of 236;P<.001). There were no differences in inpatient deaths or 30-day readmission rates. Conclusion: In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

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