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The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study

The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study
The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study
Objectives: to investigate whether a care pathway for older hip fracture patients can reduce length of stay while maintaining the quality of clinical care.
Design: prospective study of patients admitted 12 months before and after implementation of a care pathway for the management of femoral neck fracture. Audit data for corresponding time periods from nearby orthopaedic units was used to control for secular trends.
Setting: teaching hospital.
Subjects: patients aged 65 years and over with a femoral neck fracture. Exclusion criteria: multiple fractures, fractures due to malignancy, re-fracture, total hip replacement, previously entered into the study, operation performed elsewhere. Three-hundred and ninety-five (99%) and 369 (97%) case records were available for full analysis.
Main outcome measures: primary outcome: length of stay on the orthopaedic unit. Secondary outcomes: ambulation at discharge, discharge destination, in-hospital complications, 30 day mortality, readmission within 30 days of discharge, post-operative days the patient first sat out of bed and walked.
Results: mean length of stay increased by 6.5 days (95% confidence interval 3.5–9.5 days, P < 0.0005) in the second period with a significant improvement in ambulation on discharge (odds ratio 1.6, 95% confidence interval 1.0–2.6, P = 0.033) and a trend towards reduction in admission to long term care (odds ratio 0.6, 95% confidence interval 0.3–1.0, P = 0.058).
Conclusions: this care pathway was associated with longer hospital stay and improved clinical outcomes. Care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources.
elderly, hip fracture, care pathway, effectiveness
0002-0729
178-184
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253
Pickering, Ruth M.
4a828314-7ddf-4f96-abed-3407017d4c90
Onslow, Elizabeth
0bedfe6d-2818-4f9d-b31d-9393ef4a1680
Clancy, Mike
3d19521d-8495-42d5-b346-b7b89401d70e
Powell, Jackie
a9aed738-e0ec-49aa-9beb-113f8cfe0d6f
Roberts, Alison
09f01b1b-0fe3-4be4-9a7f-8931838c3ea2
Hughes, Kerry
9b98183e-2def-4c59-b890-cc11a914c08c
Coulson, Diane
236618f0-3af6-40d1-94dd-d89a02d8c536
Bray, Jane
84fb698b-d4a0-4026-8079-34c1e2ed40f1
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253
Pickering, Ruth M.
4a828314-7ddf-4f96-abed-3407017d4c90
Onslow, Elizabeth
0bedfe6d-2818-4f9d-b31d-9393ef4a1680
Clancy, Mike
3d19521d-8495-42d5-b346-b7b89401d70e
Powell, Jackie
a9aed738-e0ec-49aa-9beb-113f8cfe0d6f
Roberts, Alison
09f01b1b-0fe3-4be4-9a7f-8931838c3ea2
Hughes, Kerry
9b98183e-2def-4c59-b890-cc11a914c08c
Coulson, Diane
236618f0-3af6-40d1-94dd-d89a02d8c536
Bray, Jane
84fb698b-d4a0-4026-8079-34c1e2ed40f1

Roberts, Helen C., Pickering, Ruth M., Onslow, Elizabeth, Clancy, Mike, Powell, Jackie, Roberts, Alison, Hughes, Kerry, Coulson, Diane and Bray, Jane (2004) The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study. Age and Ageing, 33 (2), 178-184. (doi:10.1093/ageing/afh063). (PMID:14960435)

Record type: Article

Abstract

Objectives: to investigate whether a care pathway for older hip fracture patients can reduce length of stay while maintaining the quality of clinical care.
Design: prospective study of patients admitted 12 months before and after implementation of a care pathway for the management of femoral neck fracture. Audit data for corresponding time periods from nearby orthopaedic units was used to control for secular trends.
Setting: teaching hospital.
Subjects: patients aged 65 years and over with a femoral neck fracture. Exclusion criteria: multiple fractures, fractures due to malignancy, re-fracture, total hip replacement, previously entered into the study, operation performed elsewhere. Three-hundred and ninety-five (99%) and 369 (97%) case records were available for full analysis.
Main outcome measures: primary outcome: length of stay on the orthopaedic unit. Secondary outcomes: ambulation at discharge, discharge destination, in-hospital complications, 30 day mortality, readmission within 30 days of discharge, post-operative days the patient first sat out of bed and walked.
Results: mean length of stay increased by 6.5 days (95% confidence interval 3.5–9.5 days, P < 0.0005) in the second period with a significant improvement in ambulation on discharge (odds ratio 1.6, 95% confidence interval 1.0–2.6, P = 0.033) and a trend towards reduction in admission to long term care (odds ratio 0.6, 95% confidence interval 0.3–1.0, P = 0.058).
Conclusions: this care pathway was associated with longer hospital stay and improved clinical outcomes. Care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources.

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More information

Published date: 1 March 2004
Keywords: elderly, hip fracture, care pathway, effectiveness
Organisations: Community Clinical Sciences, Clinical Neurosciences, Medical Education, Social Work Studies

Identifiers

Local EPrints ID: 341831
URI: http://eprints.soton.ac.uk/id/eprint/341831
ISSN: 0002-0729
PURE UUID: 66118b96-ed48-4c31-812e-e807133d167c
ORCID for Helen C. Roberts: ORCID iD orcid.org/0000-0002-5291-1880

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Date deposited: 07 Aug 2012 11:55
Last modified: 09 Jan 2022 03:11

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Contributors

Author: Elizabeth Onslow
Author: Mike Clancy
Author: Jackie Powell
Author: Alison Roberts
Author: Kerry Hughes
Author: Diane Coulson
Author: Jane Bray

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