Abstract
Purpose/Introduction: The number of hip fractures is rising, due to increases in life expectancy. In such cases, patients are at risk from post-operative complications and subsequently the average length of hospitalization may be extended. In 2011, we established a clinical pathway (CP), a specific model of care for patient-care management, to improve the clinical and economic outcomes of proximal femoral fracture management in elderly patients. The goal was to evaluate the CP using clinical, process, and financial indicators.Methods: We included all surgical patients aged 65 and over, admitted to the emergency department with a fracture of the proximal femur following a fall. Assessment parameters included three performance indicators: clinical, process, and financial. The clinical indicators were the presence or absence of acute delirium on the third post-operative day, diagnosis of nosocomial pneumonia, and the number of patients fulfilling at least 75% of their nutritional requirements at the end of the hospitalization period. The process indicator was the time interval between arrival at the emergency department and surgery. The financial indicator was based on the number of days spent in hospital.Results: From 2011 to 2013, 669 patients were included in the CP. We observed that the average length of stay in hospital decreased as soon as the CP was implemented and stabilized afterwards. The goal of 90% of patients undergoing surgery within 48 h of arrival in the emergency department was surpassed in 2013 (93.1%). Furthermore, we observed an improvement in the clinical indicators.Conclusion: The application of a CP allowed an improvement in the qualitative and quantitative efficiency of proximal femoral fracture management in elderly patients, in terms of clinical, process, and financial factors.
Highlights
Due to the increase in life expectancy, and the rise in the average age of the population, the number of hip fractures is still growing
We observed that the average length of stay in hospital decreased as soon as the clinical pathway (CP) was implemented and stabilized afterwards
Over 200 patients annually, present with fractures of the proximal part of the femur, which require extended mean periods of hospitalization, subsequently resulting in elevated medical costs. Many of these patients suffer from undernutrition [2] and post-operative delirium [3], which can lead to post-operative complications, institutionalization, or death
Summary
Due to the increase in life expectancy, and the rise in the average age of the population, the number of hip fractures is still growing. Some publications [6,7,8] show encouraging results using various CP programs This CP, founded on evidence-based medicine guidelines, proposed to establish a system of patient-care management, for a specific patient population, involving a multidisciplinary team [9].This created interdisciplinary associations between emergency physicians, surgeons, nurses, unit management, responsible for the flow of patients through the system, physiotherapists, geriatricians, specialists in osteoporosis, and nutritionists. We evaluated this proximal femoral fracture CP, using clinical, process, and financial indicators
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