Choong P F, Langford A K, Dowsey M M, Santamaria N M
Department of Orthopaedics, St Vincent's Hospital, Melbourne, Vic.
Med J Aust. 2000 May 1;172(9):423-6. doi: 10.5694/j.1326-5377.2000.tb124038.x.
To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur.
Prospective, pseudorandomised, controlled trial.
St Vincent's Hospital, Melbourne, Victoria (a tertiary referral, university teaching hospital), 1 October 1997 to 30 November 1998.
111 patients (80 women and 31 men; mean age, 81 years) admitted via the emergency department with a primary diagnosis of fractured neck of femur.
Management guided by a clinical pathway (55 patients) or established standard of care (control group, 56 patients).
Timing of referrals and discharge planning; total length of stay; and complication and readmission rates within 28 days of discharge.
Patients managed according to the clinical pathway had a shorter total stay (6.6 versus 8.0 days; P = 0.03), even if assessment for placement by the Aged Care Assessment Service was required (9.5 versus 13.6 days; P = 0.03). There were no significant differences in complication and readmission rates between pathway and control patients (complication rates, 24% versus 36%; P = 0.40; readmission rates, 4% versus 11%; P = 0.28).
Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications.
评估采用临床路径管理股骨颈骨折患者的效果。
前瞻性、伪随机、对照试验。
维多利亚州墨尔本圣文森特医院（一所三级转诊大学教学医院），1997年10月1日至1998年11月30日。
111例经急诊科收治的股骨颈骨折初诊患者（80例女性，31例男性；平均年龄81岁）。
采用临床路径进行管理（55例患者）或采用既定的护理标准（对照组，56例患者）。
转诊和出院计划的时间；总住院时间；出院后28天内的并发症和再入院率。
按照临床路径管理的患者总住院时间较短（6.6天对8.0天；P = 0.03），即使需要老年护理评估服务进行安置评估时也是如此（9.5天对13.6天；P = 0.03）。路径组和对照组患者的并发症和再入院率无显著差异（并发症发生率，24%对36%；P = 0.40；再入院率，4%对11%；P = 0.28）。
股骨颈骨折患者的多学科协调护理可缩短住院时间且不增加并发症。
