A Cost-Benefit Study of Geriatric-Orthopaedic Management of Patients with Fractured Neck of Femur

Having identified WOMEN over 65 with the condition, fractured neck of femur, as the main cause of slow throughput and low bed availability on the acute orthopaedic wards at Huddersfield, it was decided to review existing management policies towards this group of patients. After consultation with the Orthopaedic and Geriatric Specialties, it was decided that a possible means of improving throughput was to instigate a policy of joint Geriatric-Orthopaedic management for these patients. It was envisaged that this scheme might also improve the quality of care and therefore the outcome of treatment. Six orthopaedic rehabilitation beds at St. Luke's, a mainly long stay hospital, three miles from the District General Hospital (D.G.H.), were converted into Geriatric-Orthopaedic beds. This site at the time was the main base for the district Geriatric Service as well as providing some Orthopaedic rehabilitation beds. A standardised format of Geriatric-Orthopaedic management was agreed between the two specialties. Patients admitted with this condition during the course of the year commencing March 1984, were then randomly assigned by the research team, to either the new joint management system or to single specialty Orthopaedic management as before. The evaluative criteria on which the two systems were judged can be divided into two main categories, namely costs (to the Hospital sector) and benefits (to the individual patients and to the Hospital sector). Costs taken into consideration included the number of bed days utilised (as a general indicator of fixed costs) and staff inputs into rehabilitation, e.g. physiotherapist's, occupational therapist's, social worker's time (as indicators of variable costs). Benefit, or outcome of treatment, was measured by the ability of patients in the trial to undertake standard 'activities of daily living' tests (A.D.L.s) at fixed intervals up to and including discharge (e.g. patients ability to stand, dress, etc.). Outcome was also measured in terms of a therapist's prognosis and success in returning patients back to their home environment. No difference was found in the length of hospital stay between the two groups. A marked difference was found in some of the staff inputs to patients, making joint management in total £93 per patient more expensive than ordinary orthopaedic management (1985 prices). No difference was found in the 'quality' of patients during treatment or upon discharge as measured by A.D.L. tests. A Prognosis Score was given to each patient and was unaffected by the joint management regime. Destination on discharge was also unaffected by joint management. Follow up of discharged patients is currently under way. This involves observation of the death rate since leaving hospital and obtaining details of functional abilities and home circumstances of survivors. This follow up study will form a separate report.