The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial

Abstract

BackgroundHip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect.MethodsA comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann–Whitney U-test or the Chi-squared test (Phi test). The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group.ResultsThe intervention group included 256 persons (women, 68%; mean age (SD), 78 (9) years) and the control group 145 persons (women, 72%; mean age (SD), 80 (10) years). Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours (p < 0.001), and 7 vs. 11 days (p < 0.001), respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists (ASA) classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% (p < 0.05). There were no statistically significant differences in other outcome measures.ConclusionsThe new comprehensive care pathway was associated with a significant decrease in preoperative fasting time and length of hospital stay.

Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials

“…One was a subgroup analysis of an included trial, 20 two did not record delirium as an outcome measure, 21,22 and six were not RCTs. [23][24][25][26][27][28]…”

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.…”

Improving inpatient care with the introduction of a hip fracture pathway

“…[10][11][12][13][14] Baseline measurement A retrospective baseline audit was conducted on two months of hip fracture admissions from 2013. Patients were identified from NHFD records, and data gathered from their notes.…”