Servicio de Medicina Interna, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain.
Servicio de Geriatría, Hospital Sociosanitari de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain.
Rev Clin Esp (Barc). 2022 Feb;222(2):73-81. doi: 10.1016/j.rceng.2021.04.007. Epub 2021 Sep 20.
This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures.
This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the two periods studied (June 2015-May 2016 and June 2016-May 2017).
The baseline characteristics of the population were similar in the pre-intervention period (n = 455) compared to the post-intervention period (n = 456). Patients' mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs. 15.6 days, p= .014); improved osteoporosis treatment prescribing (51.6% vs. 88%, p< .001); and reduced episodes of delirium (44% vs. 31.2%, p < .001), bronchospasm (18.3% vs. 12%, p = .019), heart failure (20% vs. 11.5%, p < .001), and COPD exacerbation (7.9% vs. 3.8%, P = .017). We observed an increase in pressure ulcers at discharge (2.9 vs. 9%, P < .001). There were no differences in the percentage of operations in less than 48 h (56% vs. 61.2% p = .64), hospital readmissions (6.9% vs. 5.9%, p = .51), or mortality (5.0% vs. 7.2%, p = .17).
The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture.
本研究旨在评估在髋部骨折患者护理过程中实施多学科临床指南的影响。
这是一项在二级医院骨科老年病房实施髋部骨折多学科临床指南后进行的前后瞻性研究。我们分析了患者的基线特征以及在两个研究期间（2015 年 6 月至 2016 年 5 月和 2016 年 6 月至 2017 年 5 月）观察到的护理和结局变量的变化。
与干预前（n=455）相比，干预后（n=456）患者的基线特征相似。患者的平均年龄为 84.8±6.8 岁，70.8%为女性。多学科临床指南的实施导致平均住院时间缩短（16.9 天比 15.6 天，p=0.014）；改善了骨质疏松症治疗处方（51.6%比 88%，p<0.001）；减少了谵妄（44%比 31.2%，p<0.001）、支气管痉挛（18.3%比 12%，p=0.019）、心力衰竭（20%比 11.5%，p<0.001）和 COPD 恶化（7.9%比 3.8%，p=0.017）。我们观察到出院时压疮的发生率增加（2.9%比 9%，p<0.001）。在<48 小时内手术的比例（56%比 61.2%，p=0.64）、医院再入院率（6.9%比 5.9%，p=0.51）或死亡率（5.0%比 7.2%，p=0.17）方面无差异。
多学科临床指南的实施改善了髋部骨折患者护理过程的各个方面。
