BACKGROUND: A geriatric hip fracture clinical pathway, led by an orthopedic surgeon, was developed in 2007. This clinical pathway team is multidisciplinary and consists of surgeons, physicians, anesthetists, nurses, physiotherapists, occupational therapists, medical social workers, dieticians as well as voluntary support groups. METHODS: From early 2007 onward, all patients older than 65 years with acute isolated hip fractures were included. During the whole inpatient treatment, all relevant data were captured prospectively. The data in 2006, before the implementation of the clinical pathway, were collected retrospectively through computer record system. A study of the length of stay in acute and rehabilitation hospital and also the short-term mortality rate was carried out to compare the difference before and after the implementation of the pathway. RESULTS: From 2007 onward, more than 1300 hip fractures were treated. After the implementation of the pathway, the preoperative length of stay was markedly shortened by 4 days, from an average of 6.1 days in 2006 to 1.5 days in 2011 (P < .05). The postoperative length of stay and the overall acute hospital length of stay also improved significantly. The length of stay in rehabilitation hospital was also significantly shorter in the 4-year period. Although the number of hip fractures increased annually with increased age and number of comorbidities each year, the inpatient mortality rate showed a gradual decrease from 2.7% in 2006 to 1.25% in 2010. The 30 days mortality rate also showed a decrease from 3.65% in 2006 to 2.75% in 2010. CONCLUSION: Geriatric hip fracture clinical pathway is an excellent approach to the geriatric hip fracture service. The most significant improvement is the dramatic shortening of the length of hospital stay. Our success in the past 5 years has proven its value and sustainability.
BACKGROUND: A geriatric hip fracture clinical pathway, led by an orthopedic surgeon, was developed in 2007. This clinical pathway team is multidisciplinary and consists of surgeons, physicians, anesthetists, nurses, physiotherapists, occupational therapists, medical social workers, dieticians as well as voluntary support groups. METHODS: From early 2007 onward, all patients older than 65 years with acute isolated hip fractures were included. During the whole inpatient treatment, all relevant data were captured prospectively. The data in 2006, before the implementation of the clinical pathway, were collected retrospectively through computer record system. A study of the length of stay in acute and rehabilitation hospital and also the short-term mortality rate was carried out to compare the difference before and after the implementation of the pathway. RESULTS: From 2007 onward, more than 1300 hip fractures were treated. After the implementation of the pathway, the preoperative length of stay was markedly shortened by 4 days, from an average of 6.1 days in 2006 to 1.5 days in 2011 (P < .05). The postoperative length of stay and the overall acute hospital length of stay also improved significantly. The length of stay in rehabilitation hospital was also significantly shorter in the 4-year period. Although the number of hip fractures increased annually with increased age and number of comorbidities each year, the inpatient mortality rate showed a gradual decrease from 2.7% in 2006 to 1.25% in 2010. The 30 days mortality rate also showed a decrease from 3.65% in 2006 to 2.75% in 2010. CONCLUSION: Geriatric hip fracture clinical pathway is an excellent approach to the geriatric hip fracture service. The most significant improvement is the dramatic shortening of the length of hospital stay. Our success in the past 5 years has proven its value and sustainability.
Entities:
Keywords:
clinical pathway; geriatric hip fractures; length of hospital stay; mortality rate; multidisciplinary
Authors: A Brainsky; H Glick; E Lydick; R Epstein; K M Fox; W Hawkes; T M Kashner; S I Zimmerman; J Magaziner Journal: J Am Geriatr Soc Date: 1997-03 Impact factor: 5.562
Authors: L A Beaupre; J G Cinats; A Senthilselvan; D Lier; C A Jones; A Scharfenberger; D W C Johnston; L D Saunders Journal: Qual Saf Health Care Date: 2006-10
Authors: John J Wixted; Mark Reed; Mark S Eskander; Bryce Millar; Richard C Anderson; Kaushik Bagchi; Shubjeet Kaur; Patricia Franklin; Walter Leclair Journal: J Orthop Trauma Date: 2008-04 Impact factor: 2.512
Authors: Helen C Roberts; Ruth M Pickering; Elizabeth Onslow; Mike Clancy; Jackie Powell; Alison Roberts; Kerry Hughes; Diane Coulson; Jane Bray Journal: Age Ageing Date: 2004-03 Impact factor: 10.668
Authors: Paul T P W Burgers; Esther M M Van Lieshout; Joost Verhelst; Imro Dawson; Piet A R de Rijcke Journal: Int Orthop Date: 2013-12-12 Impact factor: 3.075
Authors: Garin Hecht; Christina A Slee; Parker B Goodell; Sandra L Taylor; Philip R Wolinsky Journal: J Am Acad Orthop Surg Date: 2019-03-15 Impact factor: 3.020
Authors: Austin V Stone; Alexander Jinnah; Brian J Wells; Hal Atkinson; Anna N Miller; Wendell M Futrell; Kristin Lenoir; Cynthia L Emory Journal: Int Orthop Date: 2017-10-07 Impact factor: 3.479
Authors: Alexander J Bollinger; Paul D Butler; Matthew S Nies; Debra L Sietsema; Clifford B Jones; Terrence J Endres Journal: Geriatr Orthop Surg Rehabil Date: 2015-09