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Hip fracture is an important cause of mortality and morbidity in older people. The New Zealand Health Information Service (NZHIS) report on hip fracture services in NZ hospitals 1999-2000 showed that 27% of patients died within 12 months of their injury.1 Fransen followed 565 community-dwelling New Zealanders aged 60 and over with a recent hip fracture.2 By the end of 2 years, 39% of females and 52% of males had died or been institutionalised.
The NZHIS study found that a delay of more than 2 days from hip fracture to surgery is associated with increased mortality.1 This finding has been corroborated by a large study of NHS hospitals in the United Kingdom, which demonstrated an odds ratio of 1.27 for in hospital mortality in those whose operation was 2 or more days after admission, compared to those who had surgery within the first 2 days.3
At Auckland City Hospital, Orthopaedic patients aged 65 and over receive medical input from a Geriatrician or Older Peoples Health Registrar by way of twice-weekly ward rounds. Patients with hip fracture are assessed both pre and postoperatively. Following surgery, those assessed as having potential for rehabilitation are placed on the waiting list for Older Peoples Health. A weekly Ortho-Geriatric Interdisciplinary Team Meeting is held, identifying additional patients who require further rehabilitation via Older Peoples Health.
In 2006 a new initiative was introduced. Selected hip fracture patients are 'fast-tracked' to one particular Older Peoples Health (OPH) ward as soon as possible postoperatively. The aim of this is to provide a specialist care environment for these patients, thereby improving early postoperative management and potentially improving outcomes. The particular OPH ward is one of two that have an enhanced therapy establishment appropriate to rehabilitation of patients with stroke and similar high rehabilitation needs. The decision to 'fast-track' is initiated by the charge nurse on the OPH ward receiving the patient, when a bed is available. The earliest post operative patients are given priority.
Due to limitation of resources, not all hip fracture patients are able to be 'fast-tracked', with the majority receiving 'usual care' i.e. rehabilitation on the Orthopaedic ward and referral to Older Peoples Health for ongoing rehabilitation if required. Patients from Private Hospitals (facilities providing high-level long-term residential care) are not...