Page 217 - HA Convention 2016 [Full Version]

Service Enhancement Presentations HOSPITAL AUTHORITY CONVENTION 2016

F6.3 Managing Service Demands 10:45 Room 421

Does Standardised Rehabilitation and Discharge Planning Improved Functional Outcome and Efficiency of Care
in Geriatric Hip Fractures?
Law SW, Chau J, Poon C, Fung D, Lok B
Orthopedics and Traumatology Department, Tai Po Hospital, Hong Kong

Introduction

Hip fractures represents one of the most commonest cause for elderly admission and results in morbidity and mortality. As
the population ages, the burden of geriatric hip fractures is increased significantly. From an outcome and increasing service
demand perspective, an integrated model of care promoting optimal rehabilitation care and efficient flow of patients across
healthcare continuum is designed and implemented in our department since 2010 .

Objectives

(1) To determine whether implementation of an early, standardised rehabilitation and proactive discharge planning as part of
evidence-based care pathway for geriatric hip fractures will improve functional outcome and decrease institutionalisation;
and (2) to determine if care pathway implementation alters length of stay (LOS ) and process capability.

Methodology

Patients aged 65 years and above with hip fracture admitted to Tai Po Hospital between 2010 and 2015 were included
in this study. Different functional scores carried out by Physiotherapy (Elderly Mobility Score and Modified Functional
Mobility Categories) and Occupational Therapy department (Modified Barthel Index Score) were collected at admission
and discharge. LOS and institutional rate was also collected. Process capability index (Cpk) were calculated using 7 and 42
weeks as the upper and lower specification limits respectively, and the Cpk values were compared across different kinds of
data stratifications.

Results

4,047 hospitalised patients were involved with 71.2% female. Mean age was 83.2 over the five years. Functional scores
recorded showed significant improvements after rehabilitation (admission vs. discharge, p<0.01 in all scores). Mean length
of stay was 21.8 days and 67.0% of patients stayed less than 21 days in year 2015. There were significantly more patients
staying at home returned to their own place after discharge (2011 vs. 2015 = 57.7% vs. 62.7%), (All: p<0.01). Cpk values were
increasing (improving) over the five years, particularly in female patients and patients aged between 75 and 84. The findings
of our study supported the evidence that Standardised Rehabilitation and Discharge Planning as part of clinical pathway
provides positive impacts on functional outcomes and subsequent living arrangement without negative impact on LOS, and
even improves the process capacity which will help meeting the service demand in future.

Wednesday, 4 May

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