Delirium Bibliography

Reference Information

Title

Assessment of a Geriatric Hip Fracture Program: Analysis of Harmful Adverse Events Using the Global Trigger Tool

Authors

Blood, T. D. Deren, M. E. Goodman, A. D. Hayda, R. A. Trafton, P. G.

Year

2019

Journal

Journal of Bone and Joint Surgery - American Volume

Abstract

Background:The purpose of this study was to assess the impact of adding a geriatric comanagement program to the care of geriatric patients with a hip fracture at our hospital. The Institute for Healthcare Improvement (IHI) Global Trigger Tool (GTT) was used to follow the frequency and severity of adverse events occurring in hospitalized patients and to examine the effectiveness of a comanagement program (the Geriatric Hip Fracture Program [GHFP]).Methods:Data were collected for patients treated for a hip fracture from 2010 to 2014, which was 1 year prior to (October 2010 to September 2011) and 2 years after the implementation of the GHFP, and were grouped into 3-month intervals for analysis. The patients treated prior to the implementation of the GHFP were compared with those treated following the implementation of the program. The frequency and severity of adverse events were collected using the GTT.Results:There were 75.9 patients with an adverse event and 160.7 adverse events per 100 admissions. After the institution of the GHFP, there was a significant decrease in the number of patients with adverse events and the number of adverse events per 100 admissions over time. The rate of adverse events decreased by 12% per year when acute blood loss anemia was excluded. Similarly, the number of adverse events (excluding blood loss anemia) decreased significantly over time, from 128.7 per 100 admissions before the GHFP to 34.2 in the last quarter. Multivariable analysis (excluding acute blood loss anemia) demonstrated a trend toward a decreased likelihood of a patient experiencing an adverse event after the institution of the GHFP as well as a trend toward a decrease in the number of adverse events per patient. The length of the hospital stay was significantly shorter after the implementation of the GHFP.Conclusions:The implementation of the GHFP reduced the number of adverse events over time. Increasing age and the Carlson Comorbidity Index (CCI) were predictors of adverse events, while only age was a predictor of readmissions and CCI was a predictor of death in our study. The implementation of the GHFP has played an important role at our institution in quantifying the decrease in adverse events over a 2-year period, and we believe that it is essential for improving care of geriatric patients with a hip fracture.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID

30994588 

Keywords

acute blood loss anemia
age
aged
anemia
article
Charlson Comorbidity Index
clinical effectiveness
controlled study
death
disease severity
female
femoral neck fracture
femur intertrochanteric fracture
frequency
geriatric care
Geriatric Hip Fracture Program
Global Trigger Tool
health program
hip fracture
hospital admission
hospital patient
hospital readmission
human
length of stay
major clinical study
male
musculoskeletal disease assessment
postoperative delirium
predictor variable
priority journal
risk factor
trend study
urinary tract infection
very elderly

Page(s)

704-709

Volume

101

Issue

8