Auckland City Hospital's ortho-geriatric service: an audit of patients aged over 65 with fractured neck of femur.

BACKGROUND: The process of care of older patients with fractured neck of femur at Auckland City Hospital has recently changed with selected patients "fast-tracked" as soon as possible postoperatively to a specialised Older People's Health (OPH) ward.

AIMS: The aims of this study were: to evaluate patient characteristics; to analyse process of care; to compare outcomes in those "fast-tracked" patients with those receiving usual care; and to compare this information with previous data from Auckland City Hospital and other centres in New Zealand.

METHOD: Prospective case record audit of patients with fractured neck of femur aged 65 years and over admitted under Orthopaedics over a 4-month period.

RESULTS: 115 patients were audited; mean age was 84 years, 77% were female. Inpatient mortality was 5%. Twenty-four percent of patients had surgery within 24 hours of admission. Of those who did not have surgery within 24 hours, 39% were awaiting operating theatre availability. Median overall length of stay (LOS) was 27 days. Eighty-four percent of patients were transferred to Older Peoples Health. Considering all patients, 70% of those living at home pre-fracture returned home on discharge. However, only 26% of those in Rest Home returned to Rest Home. Overall, 35% of patients were discharged to a higher level of care. Forty-four percent of the group were able to walk unaided prior to hip fracture, but only 1% on discharge. Forty-three patients were "fast-tracked" to Older Peoples Health. Their median overall LOS was 23 days compared to 28 days for those receiving usual care. This was due to the shorter time in Orthopaedics. Thirty-three percent of this group went to a higher level of care on discharge compared to 35% in the group that received usual care.

CONCLUSIONS: Many patients experience a delay to surgery for non-medical reasons. The percentage transferred to Older Peoples Health is high. Fast-tracking to Older Peoples Health shortens overall length of stay due to fewer days in Orthopaedics. Many patients require a higher level of care after hip fracture, particularly if already resident in Rest Home. Demographics and inpatient mortality are comparable, but total length of stay is longer than similar New Zealand studies due to a longer length of stay in Older Peoples Health. Review of previous data from Auckland City Hospital and from other New Zealand centres shows significant variability in process of care for older patients with hip fracture.