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Clinical pathway for fractured neck of femur: a prospective, controlled study
P F Choong1, A K Langford, M M Dowsey
1Department of Orthopaedics, St Vincent's Hospital, Melbourne, Vic. PeterChoong@c031.aone.net.au
Objective:
To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur.
Design:
Prospective, pseudorandomised, controlled trial.
Setting:
St Vincent's Hospital, Melbourne, Victoria (a tertiary referral, university teaching hospital), 1 October 1997 to 30 November 1998.
Participants:
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.
Interventions:
Management guided by a clinical pathway (55 patients) or established standard of care (control group, 56 patients).
Main Outcome Measures:
Timing of referrals and discharge planning; total length of stay; and complication and readmission rates within 28 days of discharge.
Results:
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).
Conclusion:
Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications.