title: Can geriatric hip fractures be managed effectively within a level 1 trauma center?
abstract: OBJECTIVE
  To determine whether geriatric hip fractures can be managed effectively within a level 1 trauma center.
  
  
  METHODS
  A prospective observational cohort study with a historical control group.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  A total of 199 patients admitted under our hip fracture service were prospectively identified from 2011-2012. These were compared with 191 hip fracture patients who were admitted before the service.
  
  
  METHODS
  The hip fracture service includes coadmission under an orthopaedic and a geriatric team. A daily, consultant-led operating list was made available for hip fracture surgery. A "neck of femur" nurse was employed to coordinate patient care.
  
  
  METHODS
  Time to surgery, length of stay, discharge destination, and mortality. A cost-benefit analysis and a comparison with a lower acuity hospital were also performed.
  
  
  RESULTS
  Since the hip fracture service, more patients underwent surgery within 48 hours (67% vs. 52%; P = 0.004), the length of stay significantly decreased from 26 to 22 days (P = 0.004), significantly more patients were admitted to the rehabilitation unit (58.7% vs. 3.5%; P < 0.001) and ultimately discharged to their own residence (51.6% vs. 40.5%; P = 0.034). Inpatient mortality rates did not change significantly (7.5% vs. 6.8%; P = 0.780). The estimated cost saving in 2011 was $981,040.
  
  
  CONCLUSIONS
  Only minor changes are required to significantly improve the management of geriatric hip fracture patients. These patients can be managed effectively within a level 1 trauma center when an organized service prioritizing these patients is used.
  
  
  METHODS
  Therapeutic level III. See Instructions for authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Shi-Neng James
authors.initials: SN
authors.lastname: Ling
authors.forename: Christopher
authors.initials: C
authors.lastname: Kleimeyer
authors.forename: Genni
authors.initials: G
authors.lastname: Lynch
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Burmeister
authors.forename: Diana
authors.initials: D
authors.lastname: Kennedy
authors.forename: Kate
authors.initials: K
authors.lastname: Bell
authors.forename: Leith
authors.initials: L
authors.lastname: Watkins
authors.forename: Cameron
authors.initials: C
authors.lastname: Cooke
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006620:Hip Fractures / Q000191:economics / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010351:Patient Discharge; D011446:Prospective Studies; D014193:Trauma Centers / Q000191:economics / Q000458:organization & administration