Abstract
Background and purpose — We established a care pathway for hip fracture patients, a “Hip Fracture Unit” (HFU), aiming to provide better in-hospital care and thus improve outcome. We compared the results after introduction of the HFU with a historical control group.Patients and methods — The HFU consisted of a series of measures within the orthopedic ward, such as reducing preoperative waiting time, increased use of nerve blocks, early mobilization, and osteoporosis treatment. 276 patients admitted from May 2014 to May 2015 constituted the HFU group and 167 patients admitted from September 2009 to January 2012 constituted the historical control group. Patients were followed prospectively up to 12 months post fracture.Results — Mean preoperative waiting time was 24 hours in the HFU group and 29 hours in the control group (p = 0.003). 123 patients (47%) in the HFU were started on anti-osteoporosis treatment while in hospital. “Short Physical Performance Battery” score (SPPB) was mean 5.5 in the HFU group and 3.8 in the control group at 4 months (p < 0.001), and 5.7 vs. 3.6 at 12 months (p < 0.001). The mortality rate at 4 months was 15% in both groups. No statistically significant differences were found in readmissions, complications, new nursing home admissions, in Barthel ADL index or a mental capacity test at the follow-ups.
Highlights
Patients and methods — The Hip Fracture Unit” (HFU) consisted of a series of measures within the orthopedic ward, such as reducing preoperative waiting time, increased use of nerve blocks, early mobilization, and osteoporosis treatment. 276 patients admitted from May 2014 to May 2015 constituted the HFU group and 167 patients admitted from September 2009 to January 2012 constituted the historical control group
Mean preoperative waiting time was 24 hours in the HFU group and 29 hours in the control group (p = 0.003). 123 patients (47%) in the HFU were started on antiosteoporosis treatment while in hospital
Complication rates are known to increase with prolonged preoperative waiting time (Simunovic et al 2010, Westberg et al 2013, Pincus et al 2017) and acceptable waiting times according to guidelines and national recommendations vary from 24 to 48 hours (AAOS 2014, NICE 2017)
Summary
Patients and methods — The HFU consisted of a series of measures within the orthopedic ward, such as reducing preoperative waiting time, increased use of nerve blocks, early mobilization, and osteoporosis treatment. 276 patients admitted from May 2014 to May 2015 constituted the HFU group and 167 patients admitted from September 2009 to January 2012 constituted the historical control group. Patients and methods — The HFU consisted of a series of measures within the orthopedic ward, such as reducing preoperative waiting time, increased use of nerve blocks, early mobilization, and osteoporosis treatment. Mean preoperative waiting time was 24 hours in the HFU group and 29 hours in the control group (p = 0.003). Interpretation — We found improved preoperative waiting time and better SPPB score at 4 and 12 months postoperatively after introducing the HFU. Improved perioperative care and early rehabilitation may reduce mortality, prevent loss of function, and be cost effective (Kristensen et al 2016, NICE 2017). The HFU was constituted of elements thought to improve the quality of care, such as reducing preoperative waiting time, preoperative femoral nerve block to reduce opiates, early mobilization, and secondary prophylaxis
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