RESUMEN
The elderly patient presenting with an acute surgical abdomen or bowel obstruction has become a common and challenging situation. These patients bring comorbidity and frailty that necessitate appropriate risk assessment and comprehensive perioperative management. Robust communication is required between patients, families and health professions. The Australia and New Zealand Emergency Laparotomy Audit-Quality Improvement (ANZELA-QI) study is based on the United Kingdom's National Emergency Laparotomy Audit (NELA) and will gather large scale data, providing hospital-level information to enable clinicians to reduce variation in management. Successful management of the elderly laparotomy patient requires close coordination between surgeons, anaesthetists and physicians. The ANZELA-QI study will help establish the role of collaborative models of care and the need for perioperative care teams.
Asunto(s)
Abdomen Agudo/cirugía , Urgencias Médicas , Servicio de Urgencia en Hospital , Laparotomía/métodos , Mejoramiento de la Calidad , Medición de Riesgo/métodos , Abdomen Agudo/epidemiología , Anciano , Salud Global , Humanos , Incidencia , Tasa de Supervivencia/tendenciasRESUMEN
OBJECTIVES: To determine the association between management standards and clinical outcomes among patients with hip fracture (HF). METHODS: Data from a prospective cohort study were linked with hospital administration data. RESULTS: In 2014 and 2015, 493 patients had surgery for HF. The proportion of patients meeting care standards ranged from 69% for surgery within 48 hours to 96% for being seen by a geriatrician. Thirty-nine per cent of patients received all the standards. The mean waiting time for surgery was 44 hours (median, 34 hours; interquartile range [IQR], 22-58 hours). The mean length of stay for patients who were alive at discharge was 17 days (median, 13 days; IQR, 6-24 days). Fifty-six patients were readmitted within 28 days of discharge (12%), and 40 patients died within 28 days of admission (8.1%). Patients who received all standards were less likely to be readmitted or die. Surgery within 48 hours and being seen by a physiotherapist were associated with a lower mortality rate. CONCLUSIONS: The management standards, collectively and in particular, assessment by a physiotherapist and surgery within 48 hours were significantly associated with better clinical outcomes.
Asunto(s)
Fracturas de Cadera/rehabilitación , Fracturas de Cadera/cirugía , Alta del Paciente/normas , Cuidados Posoperatorios/normas , Guías de Práctica Clínica como Asunto , Rehabilitación/normas , Adulto , Anciano , Anciano de 80 o más Años , Australia , Estudios de Cohortes , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Estudios Prospectivos , Rehabilitación/estadística & datos numéricos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To examine the validity of routinely collected data in identifying hip fractures (HFs) and to identify factors associated with incorrect coding. METHOD: In a prospective cohort study between January 2014 and June 2016, HFs were identified using physician diagnosis and diagnostic imaging and were recorded in a Registry. Records of HFs in the health information exchange (HIE) were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification/Australian Classification of Health Interventions/Australian Coding Standards codes. New HFs were estimated by episode of care, hospital admission and with an algorithm. Data from the HIE and the Registry were compared. RESULTS: The number of HFs as the principal diagnosis (PD) recorded by episode (864) was higher than by admission (743), by algorithm (711) and in the Registry (638). The sensitivity was high for all methods (90-93%) but the positive predictive value was lower for episode (68%) than for admission (80%) or algorithm (81%). The number of HFs with surgery recorded in the PD by episode (639), algorithm (630) and in the Registry (623) was similar but higher than by admission (589). The episode and algorithm methods also had higher sensitivity (91-92%) than the admission method (84%) for HFs with surgery. Factors associated with coding errors included subsequent HF, long hospital stay, intracapsular fracture, younger age, male, HF without surgery and death in hospital. CONCLUSIONS: When it is not practical to use the algorithm for regular monitoring of HFs, using PD by admission to estimate total HFs and PD by episode in combination with a procedure code to estimate HFs with surgery can produce robust estimations.
Asunto(s)
Recolección de Datos/normas , Fracturas de Cadera/epidemiología , Hospitalización , Centros de Atención Terciaria , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Codificación Clínica/normas , Femenino , Intercambio de Información en Salud , Humanos , Clasificación Internacional de Enfermedades , Modelos Logísticos , Masculino , Estudios Prospectivos , Sistema de RegistrosRESUMEN
OBJECTIVE: To explore the relationship between resilience and rehabilitation outcomes in older orthopaedic patients. METHODS: Geriatric rehabilitation patients admitted to a general metropolitan hospital following a fracture were interviewed face-to-face. Their resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC), and rehabilitation outcomes were assessed according to functional independence measure (FIM) gain, length of stay, discharge destination and mortality rate. RESULTS: A total of 29 patient interviews were used in data analysis. Resilience scores varied from 49-92, with an average of 73, representing overall high resilience compared to general population samples. Resilience scores as measured by the CD-RISC did not correlate with functional improvements during rehabilitation postfracture. CONCLUSION: Further studies, including patients with a broader range of resilience scores, particularly at the lower end of the spectrum, are required to explore the relationship between resilience and rehabilitation outcomes in greater depth.