Preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission for surgical repair.

BACKGROUND: Recognizing a patient's needs during the emergency department to operating room interval is crucial to identify areas for improvement. A review of the literature provided no pertinent research regarding this phase of the preoperative experience. PURPOSE: This descriptive study examined the preoperative care management of patients with hip fractures during the wait time between emergency department discharge and operating room admission. METHOD: Data were collected through a systematic retrospective chart review. Demographic variables included gender, age, and comorbidities. Preoperative patient variables included type of analgesia, level of pain, antiembolism interventions, fluid intake, sensory perception/cognition, mobility, and nutritional intake. Subjects were patients cared for at 3 sites in a large multihospital system. A total of 137 charts were reviewed. FINDINGS: Although findings were not statistically significant, opportunities to improve care were identified. More attention is needed to evaluate patients effectively for pain, particularly where there are cognitive deficits. Designing and implementing a program for increased bed mobility and protocols that closely monitor and manage fluid intake may offset postoperative complications.

Postoperative benefits of intrathecal injection for patients undergoing total knee arthroplasty.

PURPOSE: The purpose of the study was to compare postoperative outcomes in patients undergoing total knee replacement via general anesthesia with patients receiving an intrathecal injection for anesthesia. DESIGN: A two-group comparison design was selected to differentiate pain control, ambulation distance, and length of hospital stay in total knee arthroplasty patients. SAMPLE: A random sample of 85 patients receiving a total knee arthroplasty by the same surgeon were selected. Forty-four patients received general anesthesia, and 41 patients received an intrathecal injection. FINDINGS: The overall effect of pain control was greater in patients with intrathecal injections up to 48 hours after arrival on the orthopedic unit. Ambulation distance was greater for intrathecal patients for the first three therapy sessions. IMPLICATIONS FOR NURSING PRACTICE: The use of an intrathecal injection for pain management changes postoperative nursing care planning and interventions. Improved pain control results in more alert and responsive patients and earlier ambulation. Patient teaching for prevention of complications and self-care postdischarge can begin earlier.

Comparing excess costs across multiple corporate populations.

The purpose of this study was to examine the relationship of health risk level to charged medical costs and determine the excess cost of higher risk individuals compared to low risk. Two years of medical claims from six corporations were used to determine costs of health risk assessment (HRA) participants and nonparticipants. A total of 165,770 employees, 21,124 of which took an HRA, were used for the study. Costs increased as risk level increased. There were no significant differences within a risk level between companies for the cost ratio. Percent of medical costs due to excess risk ranged from 15.0-30.8% for HRA participants and 23.8-38.3% for the study population. Cost patterns were consistent across companies. Excess cost as the result of increased risk level accounted for a substantial portion of the cost at each company. These results can be used to justify the need for a health-promotion program and to estimate potential savings as the result of excess risk. Even without the use of an HRA, health practitioners should feel confident stating that excess risk accounts for at least 25% to 30% of medical costs per year across a wide variety of companies, regardless of industry or demographics. The numbers can be used as a realistic estimate for any health promotion program financial proposal.