Use of Standardized Tests and Measures to Guide Acute Care Discharge Recommendations Following a Hip Fracture

Background and Purpose: Rehabilitation for patients following hip fracture begins postoperatively in acute care. Physical therapists must consider multiple factors, in light of known prognostic indicators, to determine appropriate discharge recommendations. This case report reviews clinical decision making and the use of standardized outcome measures to guide discharge planning for a patient who underwent surgery for hip fracture in the acute care setting. Case Description: A 67-year-old woman with a right intertrochanteric hip fracture admitted to the hospital requiring surgical stabilization was examined, evaluated, and treated by the primary author of this report. On the basis of the literature, assessment of functional mobility, pain, hemoglobin levels, and objective criteria was used to determine discharge disposition. Outcomes: The patient's functional mobility, pain, gait speed, and functional reach improved. Gait speed and functional reach values indicated that she was at a high risk for falls. In addition, hemoglobin levels remained low. Using these criteria, the therapist recommended discharge to a skilled nursing facility. Discussion: The synthesis of known prognostic indicators for recovery from hip fracture in combination with objective outcome measures was critical in determining the final discharge recommendation. This process has the potential to improve objectivity in acute care clinical decision making.