Roberts, Helen C., Pickering, Ruth M., Onslow, Elizabeth, Clancy, Mike, Powell, Jackie, Roberts, Alison, Hughes, Kerry, Coulson, Diane and Bray, Jane
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), . (doi:10.1093/ageing/afh063). (PMID:14960435).
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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-Wve (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, postoperative
days the patient Wrst sat out of bed and walked.
Results: mean length of stay increased by 6.5 days (95% conWdence interval 3.5–9.5 days, P<0.0005) in the second period
with a signiWcant improvement in ambulation on discharge (odds ratio 1.6, 95% conWdence interval 1.0–2.6, P=0.033) and
a trend towards reduction in admission to long term care (odds ratio 0.6, 95% conWdence 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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