Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Abstract

Purpose Modern management of the elderly with a hip fracture is complex and costly. The aim of this study was to compare the treatment-related hospital length of stay (HLOS) before and after implementing a clinical pathway for patients undergoing hip fracture surgery. Methods This was a retrospective, before-and-after study. The first period ranged from June 21, 2008 to November 1, 2009 (N =212), and the second was from January 7, 2010 to July 7, 2011 (N =314). The electronic hospital system and patients records were reviewed for demographics, HLOS, mortality, complications and readmissions. Results In the first period 53 % had a femoral neck fracture, of which 57 % were treated with hemiarthroplasty. In the second period this was 46 % and 71 %. Pertrochanteric fractures were treated with a Gamma nail in 85 % in the first period, and in 92 % in the second period. The median HLOS decreased from nine to six days (p <0.001). For the hemiarthroplasty group HLOS decreased from nine to seven days (p <0.001); for internal fixation there was no significant difference (five versus six days, p =0.557) and after Gamma nailing it decreased from ten to six days (p <0.001). For mortality no statistically significant difference was found (6 % versus 5 %, p =0.698). Complications decreased for the Gamma nail group (44 % versus 31 %, p =0.049). Readmissions for the total group were not different (16 % versus 17 %, p =0.720).Conclusions Implementing a clinical pathway for hip fractures is a safe way to reduce the HLOS and it improves the quality of care.

Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers?

“…Such studies should seek to understand whether this phenomenon can be reproduced in other datasets, generalized beyond California, and whether any disadvantages associated with treatment in a regional center are subject to mitigation, for example, by strengthening clinical care pathways for vulnerable patient groups. 37,38 In the future, consistent evidence for this phenomenon could justify changes to prehospital triage protocols. Such changes might permit L1TCs to concentrate resources and expertise on severely injured patients and other dedicated institutions to focus on the specialist needs of older adults with hip fractures.…”

Impact of the Orthopaedic Nurse Practitioner role on acute hospital length of stay and cost‐savings for patients with hip fracture: A retrospective cohort study

“…A hip fracture is a devastating event for a patient. Many studies (Biber et al., ; Burgers et al., ; Flikweert et al., ; Gupta, ; Lau et al., ; Leigheb et al., ; Lynch et al., ; Neuman et al., ; Zeltzer et al., ) have confirmed that using a hip fracture clinical pathway and an ortho‐geriatrician‐led program can improve clinical outcomes for patients with minimal trauma hip fracture. The major findings from this study show that the implementation of the role of the ONP to co‐ordinate care for patients with hip fracture decreased the acute hospital LOS.…”

“…A hip fracture is a devastating event for a patient. Many studies (Biber et al, 2013;Burgers et al, 2014;Flikweert et al, 2014;Gupta, 2014;Lau et al, 2013;Leigheb et al, 2012;Lynch et al, 2015;Neuman et al, 2009;Zeltzer et al, 2014) Similar to the Nurse Practitioner role, the ONP in this study coordinated the delivery of patient care with the multidisciplinary team that was in alignment with evidenced-based practice; the role provided expert guidance and consultation; clinical and professional leadership; daily patient rounds and chart reviews; presented diagnostic treatment options to patients and families; organized referrals as applicable and prepared the patient and multidisciplinary team for discharge planning and follow-up (Kutzleb et al, 2015).…”

“…An ortho-geriatrician-led program includes a geriatrician and the multidisciplinary team and also standardizes care processes. Several studies have shown improved outcomes for patients with hip fractures, through the implementation of a clinical pathway, with most studies showing a reduction in the acute hospital LOS (Burgers, Van Lieshout, Verhelst, Dawson, & De Rijcke, 2014;Flikweert, Izaks, Knobben, Stevens, & Wendt, 2014;Lau, Fang, & Leung, 2013;Leigheb et al, 2012). In addition, two systematic reviews (Leigheb et al, 2012;Neuman et al, 2009) have found clinical pathways to be significantly associated with reduced risk of complications.…”

Research and Development of Semantics-based Sharable Clinical Pathway Systems

“…Thus, greater focus is now being placed on delivering cost-effective, efficient health care and at the same time improving medical quality. The clinical pathway (CP) as a medical management schema can reduce the length of hospital stays, decrease health care costs, standardize clinical activities, and optimize patient outcomes [1][2][3][4][5][6][7].…”