PSH Model of Care Reduces Death and Emergency Visits in Hip Fracture Patients

    Older adult patients who had emergency repair of a fractured hip were much less likely to die or make a return visit to the emergency department (ED) after discharge if they received care under the Perioperative Surgical Home (PSH) model of care, suggests research presented at the ANESTHESIOLOGY 2017 annual meeting.

    PSH patients were also far more likely to go home, rather than to a rehabilitation facility, after discharge from the hospital, according to the study. The PSH is a patient-centric, physician-led, team-based system of coordinated care that guides patients through the entire surgical experience, from the decision to undergo surgery to discharge and beyond.

    “The PSH has fundamentally changed the outcomes that matter to patients, which is particularly impressive in this extremely high-risk population,” said Chunyuan Qiu, MD, lead author of the study and physician anesthesiologist at Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California.

    “Our research suggests the PSH is beneficial not just for patients having planned procedures, but also for those having high-risk emergency surgeries.”

    Dr. Qiu’s institution created a PSH protocol that is activated when a patient is admitted to the ED with a likely hip fracture. The operator contacts and loops in the various teams, including the ED, anesthesiology, orthopaedics, internal medicine, and operating-room scheduling so they can begin readying the patient for surgery within 24 hours. The various teams coordinate as they manage preparations for surgery, including pain control, blood tests, imaging and optimizing medical problems and medications prior to surgery. 

    The single-center study presented at ANESTHESIOLOGY 2017 compared outcomes of 222 hip fracture patients treated prior to the implementation of the PSH with 118 patients who were treated after implementation. The research showed:

    • Death rates for the PSH group were reduced by half or more: 1.7% of non-PSH patients died in the hospital, compared with less than 1% of PSH patients. Thirty days after discharge 3.2% of non-PSH patients died versus none of the PSH patients, and after 90 days, 6.3% of non-PSH and 2.5% of PSH patients died.
    • PSH patients were less likely to visit the ED after they were discharged from the hospital after surgery: 9.5% of non-PSH patients versus 5.1% of PSH patients visited the ED within 30 days after discharge, while 23.4 % of non-PSH patients and 14.4% of PSH patients went to the ED within 90 days of discharge.
    • PSH patients were much more likely to be discharged to their homes instead of a nursing home or other rehabilitation facility: 16.2% of non-PSH patients went directly home, compared with 40.7% of PSH patients.

    Although 30-day hospital readmissions were slightly higher in the PSH group (13.6%) than in the non-PSH group (12.6%), the difference was statistically insignificant. In addition, 90-day readmissions were significantly lower in the PSH group (17.8%) than in the non-PSH group (23.9%).

    “Hip fractures are extremely expensive, and we found the PSH significantly reduces those costs,” Dr. Qiu said. “The model has been so successful, it is now spreading to 13 medical centers within our system.”


    Qiu C, Diekmann G, Nguyen VT, et al. Perioperative Surgical Home (PSH) Practice Reduce Mortality Following the Hip Fracture Surgery in Elderly: A Pilot Study (abstract A1173). Presented at ANESTHESIOLOGY 2017, October 21-25, 2017, Boston, Massachusetts.