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Effects of a Hospitalist Model on Elderly Patients With Hip Fracture
Michael P. Phy, DO;
David J. Vanness, PhD;
L. Joseph Melton III, MD;
Kirsten Hall Long, PhD;
Cathy D. Schleck;
Dirk R. Larson, MS;
Paul M. Huddleston, MD;
Jeanne M. Huddleston, MD
Arch Intern Med. 2005;165:796-801.
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.
Author Affiliations: Hospital Internal Medicine, Division of General Internal Medicine (Drs Phy and J. M. Huddleston), Division of Epidemiology (Dr Melton), Division of Health Care Policy and Research (Drs Long and J. M. Huddleston), Division of Biostatistics (Ms Schleck and Mr Larson), and the Department of Orthopedic Surgery (Dr P. M. Huddleston), Mayo Clinic College of Medicine, Rochester, Minn; and the Department of Population Health Sciences, University of Wisconsin Medical School, Madison (Dr Vanness).
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