IDENTIFYING ELDERLY PATIENTS FOR EARLY DISCHARGE AFTER HOSPITALIZATION FOR HIP FRACTURE

Background. Some elderly patients can be successfully treated in hospi tals with lengths of stay (LOS) shorter than the norms developed by th e diagnosis-related groups. This study was designed to test the hypoth esis that elderly patients with short LOS after hip fracture have char acteristics that can be identified shortly after hospital admission. M ethods. A retrospective chart review was performed of 216 patients ove r age 55 discharged alive from a university hospital after hip fractur e. Demographic, medical, and functional data available within 48 hours of admission were used to develop an algorithm to identify patients e ligible for early discharge. A prospective study of an additional 33 p atients was undertaken to test this algorithm and to examine the predi ctive value of additional functional and psychosocial information not routinely recorded in the chart. Results. Retrospective chart review i dentified 4 predictors of short LOS in multivariate analysis: age less than 75, admission from a nursing home, normality of admission labora tory results, and ''no surgery or surgery by day three.'' These variab les explain 25% of the total variation of LOS. In our prospective stud y the variable ''day of surgery'' had the greatest variance explanatio n (30.5%) in multivariate analysis. A model including day of surgery a nd the presence of dementia explained 42.5% of the variance of LOS. Co nclusion. Short LOS can be predicted within 48 hours of admission util izing data that measure severity of illness, functional status, and av ailable support. The development of algorithms to identify patients el igible for early discharge would be beneficial to care managers.