Mortality in hip fracture patients after implementation of a nurse practitioner-led orthogeriatric care program: results of a 1-year follow-up.

BACKGROUND: Hip fractures are a major cause of mortality and disability in frail older adults. Therefore, orthogeriatrics has been embraced to improve patient outcomes. With the optimal template of orthogeriatric care still unknown, and to curtail rising healthcare expenditure we implemented a nurse practitioner-led orthogeriatric care program (NPOCP). The objective was to evaluate NPOCP by measuring 3-month and 1-year mortality, compared to usual care (UC). In addition, length of stay (LOS) and location of hospital discharge were reported. METHODS: An anonymised data set, of hip fracture patients (n = 300) who presented to Maastricht University Medical Centre, the Netherlands, a level-1 trauma centre, was used. NPOCP was implemented on one of two surgical wards, while the other ward received UC. Patient allocation to these wards was random. RESULTS: In total, 144 patients received NPOCP and 156 received UC. In the NPOCP, 3-month and 1-year mortality rates were 9.0% and 13.9%, compared to 24.4% and 34.0% in the UC group (P < 0.001). The adjusted hazard ratio (aHR) for 3-month (aHR 0.50 [95%CI: 0.26-0.97]) and 1-year mortality (aHR 0.50 [95%CI: 0.29-0.85]) remained lower in NPOCP compared to UC. Median LOS was 9 days [IQR 5-13] in patients receiving UC and 7 days [IQR 5-13] in patients receiving NPOCP (P = 0.08). Thirty-eight (27.5%) patients receiving UC and fifty-seven (40.4%) patients receiving NPOCP were discharged home (P = 0.023). CONCLUSION: Implementation of NPOCP was associated with significantly reduced mortality in hip fracture patients and may contribute positively to high-quality care and improve outcomes in the frail orthogeriatric population.

Bedside palliative care and geriatric consultations: adherence rate in hospitalised patients.

OBJECTIVES: This study examined the adherence rate of recommendations of a palliative consultation team (PCT) and a geriatric consultation team (GCT). Secondary aims were to investigate which factors and/or recommendation characteristics influence adherence rates. METHODS: This retrospective cohort study was performed in the Maastricht University Medical Center+ in the Netherlands and included hospitalised patients who received a consultation by the PCT or the GCT. Baseline data on consultations were collected for the total population and for the GCT and PCT separately. The adherence rate of the recommendations was evaluated by checking evidence of implementation. The nature of recommendations given (solicited or unsolicited) was documented per domain (somatic, psychological/cognitive, social, spiritual, functional, and existential). The association with adherence was evaluated for solicited and unsolicited recommendations separately. Exploration of potentially associated factors was performed using OpenEpi. RESULTS: Overall, 507 consultations of individual patients were performed (n=131) by the GCT and (n=376) by the PCT. Most recommendations given were solicited (865/1201=72%). Over 80% of both solicited and unsolicited recommendations were implemented in the majority of domains. No potentially modifiable factors associated with the adherence of the advices were found. CONCLUSIONS: The overall adherence rate of the GCT and PCT consultations was high. In addition, in certain domains, many recommendations were unsolicited. However, also the majority of these recommendations were implemented.

Screening for Frailty in Hospitalized Older Adults: Reliability and Feasibility of the Maastricht Frailty Screening Tool for Hospitalized Patients (MFST-HP).

As nurses in hospitals are confronted with increasing numbers of older patients, their geriatric nursing skills and knowledge must be integrated into daily clinical practice. Early risk identification via screening tools may help improve geriatric care. To reduce the assessment burden of nurses, the Maastricht Frailty Screening Tool for Hospitalized Patients (MFST-HP) was developed. The aim of the current study was to explore aspects of reliability, validity, and feasibility of the MFST-HP. Intrarater reliability was assessed by measuring patients two times within 24 hours. Interrater reliability was assessed by having patients screened by two different nurses. Construct validity was studied by the associations between the MFST-HP scores and age and comorbidities. Intraclass correlation coefficients for both intra- and interrater reliability were good (>0.93). Older patients and those with more comorbidity showed higher scores on the MFST-HP compared to younger patients and those with less comorbidity. The MFST-HP shows promise as a reliable, valid, and feasible screening tool for frailty among hospitalized older adults. [Res Gerontol Nurs. 2016; 9(5):243-251.].