Age and Ageing 2004; 33: 178-184
© 2004, British Geriatrics Society
Research Paper |
The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study
1 Elderly Care Research Unit, University Geriatric Medicine, Level E Centre Block (807)
2 Medical Statistics Group, Health Care Research Unit, University of Southampton
3 Orthopaedics and Trauma
4 Accident and Emergency, Southampton General Hospital, Southampton SO16 6YD, UK
5 Department of Social Work Studies, University of Southampton, Highfield, Southampton SO17 1BJ, UK
* Current address: 2 Coleton Close, Exmouth EX8 3PU, UK
Current address: Data Management and Statistics Department, Simbec Research Ltd, Merthyr Tydfil, Wales, UK
Current address: Ravenswood House Medium Secure Unit, Knowle, Fareham, Hants PO17 5NA, UK
# Current address: Casa da Colina, Alto Fica da Benafim, 8100 Loule, Algarve, Portugal
Address correspondence to: H. C. Roberts, Elderly Care Research Unit, University Geriatric Medicine, Level E Centre Block (807), Southampton General Hospital SO16 6YD, UK. Fax: (+44) 23 807 96134. Email: hcr{at}soton.ac.uk
Abstract
Objectives: to investigate whether a care pathway for older hip fracture patients can reduce length of stay while maintaining the quality of clinical care.
Design: prospective study of patients admitted 12 months before and after implementation of a care pathway for the management of femoral neck fracture. Audit data for corresponding time periods from nearby orthopaedic units was used to control for secular trends.
Setting: teaching hospital.
Subjects: patients aged 65 years and over with a femoral neck fracture. Exclusion criteria: multiple fractures, fractures due to malignancy, re-fracture, total hip replacement, previously entered into the study, operation performed elsewhere. Three-hundred and ninety-five (99%) and 369 (97%) case records were available for full analysis.
Main outcome measures: primary outcome: length of stay on the orthopaedic unit. Secondary outcomes: ambulation at discharge, discharge destination, in-hospital complications, 30 day mortality, readmission within 30 days of discharge, post-operative days the patient first sat out of bed and walked.
Results: mean length of stay increased by 6.5 days (95% confidence interval 3.5–9.5 days, P < 0.0005) in the second period with a significant improvement in ambulation on discharge (odds ratio 1.6, 95% confidence interval 1.0–2.6, P = 0.033) and a trend towards reduction in admission to long term care (odds ratio 0.6, 95% confidence interval 0.3–1.0, P = 0.058).
Conclusions: this care pathway was associated with longer hospital stay and improved clinical outcomes. Care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources.
Keywords: elderly, hip fracture, care pathway, effectiveness
Received June 20, 2003; Revision received September 30, 2003. accepted in revised form September 30, 2003.
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