Acute Care/Hospitalization

Evidenced-based practices improve pain management and lower costs for patients hospitalized for hip fracture

Evidence-based practice (EBP) is an essential component of health care delivery. To implement EBPs, a multifaceted, translating research into practice (TRIP) intervention was used to improve the quality of acute pain management in older adults hospitalized with hip fractures. Two new studies supported by the Agency for Healthcare Research and Quality (HS10482) demonstrated that the TRIP intervention lowered pain levels experienced by these patients and cut costs. The first study showed that the quality of acute pain care increased significantly, with patients reporting lower mean pain intensity ratings. The second study found that, although it cost hospitals to implement the TRIP intervention, it more than paid for itself by lowering overall costs. Both studies are briefly summarized here.

Titler, M.G., Herr, K., Brooks, J.M., and others. (2009, February). "Translating research into practice intervention improves management of acute pain in older hip fracture patients." HSR: Health Services Research 44(1), pp. 264-287.
Each year, more than 225,000 Medicare recipients 65 years of age or older are hospitalized with painful hip fractures. While there is a great deal of evidence on acute pain management, most elderly patients do not receive adequate pain management when they are in the hospital. Researchers examined the medical records of 1,401 patients admitted with hip fractures to 12 acute care hospitals to measure the impact of a TRIP intervention on greater adoption of EBPs for acute pain management by nurses and physicians. Overall, patients participating in the TRIP intervention received more evidence-based pain practices compared with those not receiving the TRIP intervention. Those in the TRIP group were 2.7 times more likely to have their pain assessed every 4 hours during the first 3 days of their admission. There was also greater adoption of pain treatment practices by nurses participating in the TRIP intervention. These included giving more patients around-the-clock administration of opioid and nonopioid analgesics. Nurses also reported a significant decrease in barriers associated with evidence-based pain management practices, such as the lack of peer consultation. Physicians participating in the TRIP intervention also had greater adoption of these evidence-based acute pain management practices.

Brooks, J.M., Titler, M.G., Ardery, G., and Herr, K. (2009, February). "Effect of evidence-based acute pain management practices on inpatient costs." HSR: Health Services Research 44(1), pp. 245-263.
In this study, the researchers estimated cost changes associated with implementing the TRIP intervention within 12 acute care hospitals. The TRIP intervention used physician and nurse opinion leaders, educational programs, and evidenced-based practice guidelines on acute pain management in the elderly. A total of 1,401 medical records and associated costs were reviewed. The TRIP intervention reduced the cost of an average inpatient stay by just over $1,500. Contributing to these savings were a half-day reduction in length of stay and a reduction of more than $150 in cost per day. The average direct cost to get the program up and running at a hospital was $17,714. Implementing TRIP resulted in extra nursing costs as well as costs associated with special patient rooms. However, the cost increases were offset by cost savings for such things as room and board, pharmacy, laboratory, radiology, and operating room use. If a hospital treats 100 patients with hip fractures, it can expect to see a reduction in treatment costs of more than $150,000 by using the TRIP intervention. Factoring in the cost of the program, the overall cost reduction would be $132,286.

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