A comparison of surgical delays in directly admitted versus transferred patients with hip fractures: opportunities for improvement?
BACKGROUND
The increasing incidence of hip fractures in our aging population challenges orthopedic surgeons and hospital administrators to effectively care for these patients. Many patients present to regional hospitals and are transferred to tertiary care centres for surgical management, resulting in long delays to surgery. Providing timely care may improve outcomes, as delay carries an increased risk of morbidity and mortality.


METHODS
We retrospectively reviewed the cases of all patients with hip fractures treated in a single Level 1 trauma centre in Canada between 2005 and 2012. We compared quality indicators and outcomes between patients transferred from a peripheral hospital and those directly admitted to the trauma centre.


RESULTS
Of the 1191 patients retrospectively reviewed, 890 met our inclusion criteria: 175 who were transferred and 715 admitted directly to the trauma centre. Transfer patients' median delay from admission to operation was 93 hours, whereas nontransfer patients waited 44 hours (p < 0.001). The delay predominantly occurred before transfer, as the patients had to wait for a bed to become available at the trauma centre. The median length of stay in hospital was 20 days for transfer patients compared with 13 days for nontransfer patients (p < 0.001). Regional policy changes enacted in 2011 decreased the median transfer delay from regional hospital to tertiary care centre from 47 to 27 hours (p = 0.005).


CONCLUSIONS
Policy changes can have a significant impact on patient care. Prioritizing patients and expediting transfer will decrease overall mortality, reduce hospital stay and reduce the cost of hip fracture care.
From Western University, London, Ont.
Sagar J
SJ
Desai
From Western University, London, Ont.
Janak
J
Patel
From Western University, London, Ont.
Hussein
H
Abdo
From Western University, London, Ont.
Abdel-Rahman
AR
Lawendy
From Western University, London, Ont.
David
D
Sanders
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005592:Fracture Fixation; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario; D016134:Organizational Policy; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010360:Patient Transfer; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*