The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study

Roberts, Helen; Pickering, Ruth; Onslow, E.; Clancy, Mike; Powell, Jackie; Roberts, Alison; Hughes, Kerry; Coulson, Diane; Bray, J.

doi:10.1093/ageing/afh063

Cited by 109 publications

(117 citation statements)

References 11 publications

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“…Published prospective intervention studies are small and therefore underpowered to detect differences in mortality. 19,20 The purpose of the present study was to determine if our improvement intervention achieved the intended reduction in time to surgery and if a reduction in time to surgery improved mortality and length of stay (LOS). We believe that this work is unique in that it is, to our knowledge, the first adequately powered intervention study that examines the association between timely hip fracture surgery and mortality.…”

Section: Discussionmentioning

confidence: 99%

Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority

Bohm

Loucks

Wittmeier

et al. 2015

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257Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority Background: Existing literature demonstrating the negative impact of delayed hip fracture surgery on mortality consists largely of observational studies prone to selection bias and may overestimate the negative effects of delay. We conducted an intervention study to assess initiatives aimed at meeting a 48-hour benchmark for hip fracture surgery to determine if the intervention achieved a reduction in time to surgery, and if a general reduction in time to surgery improved mortality and length of stay. Methods:We compared time to surgery, length of stay and mortality between pre-and postintervention patients with a hip fracture using the Kaplan-Meier estimator and Cox proportional hazards model adjusting for age, sex, comorbidities, type of surgery and year. Results:We included 3525 pre-and 3007 postintervention patients aged 50 years or older. The proportion of patients receiving surgery within the benchmark increased from 66.8% to 84.6%, median length of stay decreased from 13.5 to 9.7 days, and crude in-hospital mortality decreased from 9.6% to 6.8% (all p < 0.001). Conclusion:Coordinated, region-wide efforts to improve timeliness of hip fracture surgery can successfully reduce time to surgery and appears to reduce length of stay and adjusted mortality in hospital and at 1 year.

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Section: Discussionmentioning

confidence: 99%

Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority

Bohm

Loucks

Wittmeier

et al. 2015

cjs

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“…A recent review by Leigheb et al showed similar reductions in the hospital length of stay in eight out of 12 studies [6]. Three studies reported a longer hospital stay [14][15][16] and one did not find any difference after implementing a clinical pathway [17].…”

Section: Discussionmentioning

confidence: 99%

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Burgers

Lieshout

Verhelst

et al. 2013

International Orthopaedics (SICOT)

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Purpose Modern management of the elderly with a hip fracture is complex and costly. The aim of this study was to compare the treatment-related hospital length of stay (HLOS) before and after implementing a clinical pathway for patients undergoing hip fracture surgery. Methods This was a retrospective, before-and-after study. The first period ranged from June 21, 2008 to November 1, 2009 (N =212), and the second was from January 7, 2010 to July 7, 2011 (N =314). The electronic hospital system and patients records were reviewed for demographics, HLOS, mortality, complications and readmissions. Results In the first period 53 % had a femoral neck fracture, of which 57 % were treated with hemiarthroplasty. In the second period this was 46 % and 71 %. Pertrochanteric fractures were treated with a Gamma nail in 85 % in the first period, and in 92 % in the second period. The median HLOS decreased from nine to six days (p <0.001). For the hemiarthroplasty group HLOS decreased from nine to seven days (p <0.001); for internal fixation there was no significant difference (five versus six days, p =0.557) and after Gamma nailing it decreased from ten to six days (p <0.001). For mortality no statistically significant difference was found (6 % versus 5 %, p =0.698). Complications decreased for the Gamma nail group (44 % versus 31 %, p =0.049). Readmissions for the total group were not different (16 % versus 17 %, p =0.720).Conclusions Implementing a clinical pathway for hip fractures is a safe way to reduce the HLOS and it improves the quality of care.

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“…This shifts care from a condition focus to meeting individual needs. However, the medical model of care dominates recovery processes and is seen in clinical pathways (Choong et al, 2000;Olsson et al, 2006;Roberts et al, 2004). Advocates of clinical pathways argue that this process benefits both patient and organisation by reducing in-hospital days and improving outcomes.…”

Section: Discussionmentioning

confidence: 99%

Older adult’s recovery from hip fracture: A literature review

Healee

McCallin

Jones

2011

International Journal of Orthopaedic and Trauma Nursing

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This paper examines studies on older adult's recovering from hip fracture and views these in relation to practice. A metasearch engine was used to access health databases to identify studies relevant to recovery from hip fracture that occurs predominantly in the older adult. Three themes emerged: professional; quality of life, and ageing status.Results suggest recovery has a predominant functional restorative focus although recovery outcome is also influenced by physical function and psychosocial factors.Results suggest that the patient-centric approach has been lost in the drive for organisational efficiency has potentially driven care delivery, which has emphasised safer interventions and improved programmes. This has reduced complications and shortened length of stay in hospital but the psychosocial factors that have a long-term affect on recovery have been lost altogether. Investigating the patient-centric approach to care for older adults recovering from hip fracture is required to balance the organisational efficiency within healthcare systems. Mental health recovery models may provide such a framework to review the patient focused approach.2

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The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study

Abstract: 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.

Cited by 109 publications

References 11 publications

Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority

Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority

Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients

Older adult’s recovery from hip fracture: A literature review

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