‘Making a difference’ a clinical pathway for hip fractures and the advance practice role in managing patients with minimal trauma hip fractures

Abstract

BackgroundIn 2006/2007 there were estimated over 16,500 patients with hip fractures in Australia, the majority (94%) were over 65 years. Patients with hip fractures nearly always require hospitalisation and surgery. AimThe aim of this study was to assess the impact of the hip fracture clinical pathway on care of the hip fracture patient. MethodThis study is a retrospective medical record audit of all minimal trauma hip fracture patients over 65 years in a large tertiary hospital over a three month period before and after implementation of the hip fracture clinical pathway. ResultsFor patients in the intervention group (n = 28, mean 86.0 years) compared with the control group (n = 33, mean 85.7 years) time to surgery was <24-h (92.9% vs. 51.5%, p = 0.001), the venous thromboembolism (VTE) risk assessment form was completed (21.4% vs. 0%, p = 0.004), VTE prophylaxis improved, fewer patients received no prophylaxis (0% vs. 33.3%, p = 0.001), pharmacological prophylaxis only (21.4% vs. 54.4%, p = 0.008) and more patients received pharmacological prophylaxis and graduated compression stockings (75.0% vs. 12.1%, p = 0.001) and were discharged with osteoporosis treatment calcium and vitamin D (35.7% vs. 6.1%, p = 0.008). ConclusionImplementation of the hip fracture clinical pathway improved time to surgery (<24 h), VTE risk assessment and prophylaxis, and osteoporosis treatment on discharge.