Foundations for Developing a Hospital in the Home Pathway Following Low Trauma Hip Fracture: Using Data to Inform the Path

Abstract

Care pathways incorporating Hospital in the Home (HITH) programs are available for people following low-trauma (osteoporotic) hip fracture (LTHF) as a strategy to reduce total length of stay (LOS), but there is no published evidence supporting the development of key components of such programs for this specific population. As a precursor to program implementation, a multidisciplinary team devised criteria for HITH eligibility and considerations for readiness for HITH transfer. This study aimed to describe the rates and timing of suitability for HITH when these criteria and considerations were applied prospectively to adults admitted with LTHF who underwent surgical fixation. Prospective, 5-month audit of patients admitted to a single facility following LTHF. Criteria for HITH inclusion/exclusion and 3 time-based safety considerations for readiness for HITH transfer (time [post-operative day, POD] to first complication, time to medical stability, time to mobilization threshold) were applied to patient-level data routinely available in the medical record. Eligibility: Of 114 patients screened, 61 (54%) were initially eligible with 41 (36%) remaining eligible over the episode-of-care. Transfer considerations: 75% of those who experienced a complication did so by POD4; 75% achieved medical stability by POD5; 75% achieved the mobility criterion by POD7; and, 75% of patients met all criteria by POD7. Using data-informed criteria and considerations, we estimate that one-third of LTHF patients will be eligible for HITH with most ready for transfer within a week post-surgery. A HITH program using safety-focused criteria may help reduce LOS for patients with LTHF.