[Multidisciplinary integrated care pathway for elderly patients with hip fractures: implementation results from Centre for Geriatric Traumatology, Almelo, The Netherlands].

OBJECTIVE

To evaluate the effects of the implementation of a multidisciplinary treatment approach at Hospital Group Twente in Almelo, Netherlands, of hip fracture patients aged 65 years and older.

DESIGN

Historical comparative cohort study.

METHOD

Two groups of patients with hip fractures were retrospectively compared. One of these groups had been treated in 2009 according to the new, multidisciplinary treatment approach; the other in 2007 by usual means. Observations included the duration of hospital stay, as well as the numbers of complications, readmissions and consultations by other specialities.

RESULTS

Included were 101 patients from 2009 and 69 from 2007. In 2009, the mean duration of hospital stay was 1 day longer than in 2007. Patients admitted to a nursing home for rehabilitation increased by 16 percentage points. The incidence of minor complications decreased by 7 percentage points; that of severe complications, 5 percentage points. The diagnosis of delirium was made significantly more often (15 percentage points more; p-value: 0.051). The rate of death decreased by 5 percentage points. The number of readmissions within 30 days declined by 14 percentage points (p-value: 0.001). Due to geriatric co-treatment (co-managed care), consultations by various specialities were fewer per patient.

CONCLUSION

No reduction in the duration of hospital stay was achieved by implementation of the multidisciplinary treatment approach. It did appear that a relationship with better short-term treatment outcomes for the elderly with hip fractures existed.