Abstract
Introduction
The number of hip fracture admissions is rising; with reduced hospital bed capacity and increasing patient numbers, care pathways must be optimised to maximise inpatient bed efficiency. There is currently significant interest in improving healthcare services across all 7 days in the United Kingdom. It is unclear whether lack of allied healthcare professional review at the weekend is detrimental to hip fracture patient care. This study aims to examine whether providing 7-day physiotherapy and occupational therapy (7DPOT) service improves outcomes for fractured neck of femur patients compared to a 5-day service (5DPOT).
Methods
All patients admitted with an acute neck of femur fracture were grouped into three cohorts, depending on provision of 7DPOT services: the initial cohort received 5DPOT between December 2012 and March 2013. Seven-day physiotherapy and occupational therapy was introduced for one year from October 2014 until September 2015 (2nd cohort). The service then reverted to 5DPOT between January to June 2016 (3rd cohort). The third cohort was utilised to nullify changes in the overall service which had occurred which were not attributable to 7DPOT. Data was collected prospectively using a specially designed audit tool.
Results
580 patients were included, with 533 patients followed out to 120 days. Introduction of 7DPOT saw improvement of documented first mobilisation with a physiotherapist from mean 1.38 days to 0.98 days (p<0.05). No significant differences were seen in inpatient length of stay between the three groups or when comparing all 5DPOT to 7DPOT. Use of 7DPOT did not lead to significant differences in initial discharge location. Mortality at 120-day follow up was observed to improve over time but was not attributable to 7DPOT.
Conclusion
This study has not shown any significant improvement in outcomes for hip fracture patients receiving 7DPOT compared 5DPOT. Given the current financial constraints on healthcare services, widespread adoption cannot be recommended.
