High risk of adverse events in hospitalised hip fracture patients of 65 years and older: results of a retrospective record review study.
OBJECTIVE
Hip fracture patients of 65 years and older are a complex patient group who often suffer from complications and difficult rehabilitation with disappointing results. It is unknown to what extent suboptimal hospital care contributes to these poor outcomes. This study reports on the scale, preventability, causes and prevention strategies of adverse events in patients, aged 65 years and older, admitted to the hospital with a primary diagnosis of hip fracture.
A retrospective record review study was conducted of 616 hip fracture patients (≥65 years) admitted to surgical or orthopaedic departments in four Dutch hospitals in 2007. Experienced physician reviewers determined the presence and preventability of adverse events, causes and prevention strategies using a structured review form. The main outcome measures were frequency of adverse events and preventable adverse events in hospitalised hip fracture patients of 65 years and older, and strategies to prevent them in the future.


RESULTS
114 (19%) of the 616 patients in the study experienced one or more adverse events; 49 of these were preventable. The majority of the adverse events (70%) was related to the surgical procedure and many resulted in an intervention or additional treatment (67%). Human causes contributed to 53% of the adverse events, followed by patient-related factors (39%). Training and close monitoring of quality of care and the health professional's performance were the most often selected strategies to prevent these adverse events in the future.


CONCLUSIONS
The high percentage of preventable adverse events found in this study shows that care for older hospitalised hip fracture patients should be improved. More training and quality assurance is required to provide safer care and to reduce the number of preventable adverse events in this vulnerable patient group.
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Hanneke
H
Merten
Department of Trauma Surgery, VU University Medical Center, Amsterdam, the Netherlands.
Paul C
PC
Johannesma
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
Sanne
S
Lubberding
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
Marieke
M
Zegers
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
Maaike
M
Langelaan
Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
Gerrolt N
GN
Jukema
Department of Surgery, Kennemer Gasthuis, Haarlem, the Netherlands.
Martin J
MJ
Heetveld
NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Cordula
C
Wagner
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D009426:Netherlands; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
GERIATRIC MEDICINE