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

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.