Development and implementation of a perioperative management guide for patients with hip fracture: Health management and clinical impact

Abstract

IntroductionHip fracture (HF) in the elderly has a high prevalence and risk of morbidity and mortality in the short and long term. It can reduce life expectancy by almost 2 years, and require permanent socio-sanitary assistance in one in 5 patients. Its management as a process where the patient takes priority over the activities of the organisation can bring new perspectives, optimisation tools and redesign of the workflow to make it more efficient. Objectiveto develop an in-hospital clinical guide for the management of patients with HR adapted to the environment, clear and concise, to be able to intervene in the best possible conditions and favour their adequate recovery. Material and methods407 patients divided into 3 groups: pre-implementation (knowing the scope of the problem and areas for improvement); implementation (after the development of the management guide) and post-implementation (valued its implementation). ResultsThe clinical results obtained with this guide allowed improving surgical programming and reducing delay times (increasing the proportion of patients operated in the first 48h and reducing the average hospital stay in 3 days), raising awareness of the problem at all Services involved, improve the management of drugs that altered hemostasia, optimise transfusion therapy and reduce hospital stay and perioperative complications. ConclusionThe implementation of this guide, with integrated global criteria, has improved the results of this process, and achieved a more efficient management, reducing the consumption of resources and as a consequence, health expenditure.