Integrated hip fracture care pathway (IHFCP): reducing complications and improving outcomes

Abstract

Introduction: Hip fractures in elderly people are increasing. A five-year Integrated Hip Fracture Care Pathway (IHFCP) was implemented at our hospital for seamlessly integrating care for these patients from admission to post discharge. We aimed to evaluate how IHFCP improved process and outcome measures in these patients. Methods: A study was conducted over a five-year period on patients with acute fragility hip fracture who were managed on IHFCP. The evaluation utilised a descriptive design, with outcomes analysed separately for each of the five years of the programme. First-year results were treated as baseline. Results: The main improvements in process and outcome measures over five years, when compared to baseline, were: (a) increase in surgeries performed within 48 hours of admission from 32.5% to 80.1%; (b) reduced non-operated patients from 19.6% to 11.9%; (c) reduced average length of stay at acute hospital among surgically (from 14.0 ± 12.3 days to 9.9 ± 1.0 days) and conservatively managed patients (from 19.1 ± 22.9 to 11.0 ± 2.5 days); (d) reduced 30-day readmission rate from 3.2% to 1.6%; and (e) improved Modified Functional Assessment Classification of VI to VII at six months from 48.0% to 78.2%. Conclusion: The IHFCP is a standardised care path that can reduce time to surgery, average length of stay and readmission rates. It is distinct from other orthogeriatric care models, with its ability to provide optimal care coordination, early transfer to community hospitals and post-discharge day rehabilitation services. Consequently, it helped to optimise patients’ functional status and improved their overall outcome.

Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study

“…12 Evidence has revealed that ‘a comprehensive multidisciplinary hip fracture care pathway’, which consists of standard bundles of care and integrated care managers engaging in patient education, care coordination, and discharge planning, can effectively reduce time to surgery, rate of in-hospital postoperative complications, mortality rate, and readmission rate. 39,40 In addition, evidence also disclosed that the implementation of an orthogeriatric co-management (OGCM) for patients with hip fracture can effectively facilitate functional gains and reduce length of hospital stay and postoperative mortality, 41,42 although the cost-effectiveness of OGCM was still criticized. 43 With knowledge of prognostic factors for patients with hip fracture prone to poor outcomes following hip surgery, medical resources including multidisciplinary hip fracture care pathway or OGCM can be appropriately implemented on these patients in need of intensive care.…”

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

“…190 studies underwent full-text review, and 69 studies were selected for final analysis ( Figure and eAppendix 3 in the Supplement ). 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 …”

Effectiveness of Perioperative Comprehensive Evaluation of Hip Fracture in the Elderly

“…Delirium is a common complication after hip fracture surgery in the elderly [ 22 ]. It can not only prolong the hospital stay and increase medical expenses but also induce dementia and seriously affect the rehabilitation of patients [ 23 ]. The pathogenesis of delirium is unclear, but preoperative targeted prevention and intervention is an effective prevention and treatment measure.…”