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Patients with hip fracture who leave the hospital too soon are at risk for worse outcomes

Patients recovering from a hip fracture who had one or more abnormal vital signs, mental confusion, heart or lung problems, or couldn't eat when they were discharged from the hospital had a 360 percent greater chance of dying and a 60 percent greater chance of readmission within 60 days, according to a new study funded by the Agency for Healthcare Research and Quality (HS09973 and HS09459).

The research team, led by Ethan A. Halm, M.D., M.P.H., of the Mount Sinai School of Medicine in New York, developed a list of what they termed "acute clinical issues," or ACIs. These are potentially dangerous problems that should be resolved prior to discharging a patient with hip fracture. They include abnormal vital signs (fever above 101 degrees F, very high or low blood pressure, very high or low heart rate, high breathing rate, poor oxygenation of the blood), an inability to eat, wound infection, acute chest pain or shortness of breath, or mental status that differs from the pre-fracture level.

In addition, the researchers found that the risk of leaving the hospital too soon was not prevented by discharging the patients to a post-acute care facility such as a rehabilitation hospital or skilled nursing home. Because even one ACI put patients at increased risk, Dr. Halm and his team caution doctors and other hospital personnel to provide more intense treatment and observation of these patients while in the hospital and to consider trying to keep them there until the ACI stabilizes. In addition, they advise doctors discharging a patient with an ACI to a post-acute care facility to provide more information to the facility about the patient's need for immediate treatment or monitoring.

The study reported on 559 patients admitted with hip fractures and discharged from four hospitals in the New York metropolitan area in 1997 and 1998. The researchers reviewed the patients' medical records, collected supplemental data during the last 2 days of hospitalization, and conducted followup at 60 days after discharge by telephone interview and querying State hospital discharge databases. Approximately 350,000 hip fractures occur annually in the United States and account for nearly $6 billion per year in hospital costs.

For more details, see "Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture," by Dr. Halm, Jay Magaziner, Ph.D., Edward L. Hannan, Ph.D., and others, in the January 13, 2003, Archives of Internal Medicine 163, pp. 107-112.

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