Table 6 Proposed mechanisms and mediators for the effect of system factors on mortality
From: Patient and system factors of mortality after hip fracture: a scoping review
Factor | Mechanism | Mediator |
|---|---|---|
Hospital volume | Patients admitted to low volume hospitals are often delayed to surgery when compared to patients admitted to high volume hospitals [56]. | Surgical delay |
Nursing staff volume | Higher nurse staffing may prevent or allow early detection of complications [28]. | Complications |
Higher nurse staffing improves operating room availability and shorten time to surgery [28]. | Surgical delay | |
Surgeon volume | Low volume surgeons may not select appropriate procedure and preoperative planning, intraoperative technique and postoperative management [34]. | Hypothesis only |
Surgical delay | Patients who are delayed to surgery are exposed to inflammatory and hypercoagulable states for longer than those who are not delayed [71, 72]. | Hypothesis only |
Hospitalization delay | Patients may receive suboptimal care prior to admission and may develop pressure ulcers, thromboembolism, uncontrolled pain or delirium [50, 61]. | Complications |
Length of stay | Institutionalized patients have shorter hospital stay than patients from community [36]. | Discharge destination |
Admission month | Patients admitted in July may be exposed to lower staffing levels in holiday period [31]. | Staffing volume |