The Domiciliary Rehabilitation and Support Program. Rationale, organisation and outcome

Abstract

Objective: To describe the Domiciliary Rehabilitation and Support Program (whose principles are early surgery, rapid mobilisation, avoidance of sedation, and early discharge with physiotherapy and nursing support provided in the home) for elderly patients with proximal femoral fractures (PFF), and to compare its costs with those of a conventional approach to the problem.

Design and setting: Prospective data accumulation on all patients admitted to a major metropolitan teaching hospital (Sir Charles Gairdner Hospital).

Patients: Six hundred and fifteen patients, 60 years or more, 76% female (mean age 82.6 +/- 8.1 years), 24% male (mean age 79.9 +/- 7.6 years).

Results: The mean length of hospital stay of patients on the program was 18.9 (+/- 27.3) days compared with 28 days for elderly PFF patients in the preceding year. The morbidity and mortality figures were comparable with or better than other published series. There was a 15% financial saving following introduction of the scheme.

Conclusion: The Domiciliary Rehabilitation and Support Program is a safe and cost effective method of dealing with elderly patients suffering from a proximal femoral fracture.