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Geriatric hip fracture clinical pathway: the Hong Kong experience
1Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, Hong Kong SAR, People's Republic of China. catcherlau@hotmail.com
Insights
Implementing a geriatric hip fracture clinical pathway improved patient care. This multidisciplinary approach reduced hospital stays and enhanced outcomes like surgical site infection and mortality rates.
Area of Science:
- Orthopaedic Trauma
- Geriatric Medicine
- Healthcare Management
Background:
- Geriatric hip fractures are common and increasing, posing significant management challenges due to patient comorbidities and social issues.
- Osteoporosis complicates fracture fixation, requiring specialized techniques and implants.
- Effective management necessitates addressing pre-morbid conditions and social complexities in elderly patients.
Purpose of the Study:
- To evaluate the impact of a multidisciplinary geriatric hip fracture clinical pathway implemented in 2007.
- To assess improvements in clinical outcomes and hospital stay duration for hip fracture patients.
Main Methods:
- A geriatric hip fracture clinical pathway was implemented in 2007, involving a multidisciplinary team.
- Data from 964 hip fracture patients managed between 2007 and 2009 were analyzed.
- Key outcomes measured included pre-operative and total hospital length of stay, surgical site infection, 30-day mortality, and pressure sore incidence.
Main Results:
- The clinical pathway significantly reduced pre-operative and total hospital length of stay by over 5 days.
- Improvements were observed in surgical site infection rates (0.98% in 2009) and 30-day mortality (1.67% in 2009).
- Early discharge planning was facilitated by active participation from physiotherapists, occupational therapists, and medical social workers.
Conclusions:
- A well-designed and executed clinical pathway can substantially improve clinical outcomes for geriatric hip fracture patients.
- Multidisciplinary collaboration is key to optimizing care and resource utilization in managing hip fractures.
- The pathway demonstrated effectiveness in enhancing patient care and reducing hospital stay durations.
Abstract:
Geriatric hip fracture is one of the commonest fractures in orthopaedic trauma. There is a trend of further increase in its incidence in the coming decades. Besides the development of techniques and implants to overcome the difficulties in fixation of osteoporosis bone, the general management of the hip fracture is also very challenging in terms of the preparation of the generally poorer pre-morbid state and complicate social problems associated with this group of patients. In order to cope with the increasing demand, our hospital started a geriatric hip fracture clinical pathway in 2007. The aim of this pathway is to provide better care for this group of patients through multidisciplinary approach. From year 2007 to 2009, we had managed 964 hip fracture patients. After the implementation of the pathway, the pre-operative and the total length of stay in acute hospital were shortened by over 5 days. Other clinical outcomes including surgical site infection, 30 days mortality and also incidence of pressure sore improved when compared to the data before the pathway. The rate of surgical site infection was 0.98%, and the 30 days mortality was 1.67% in 2009. The active participation of physiotherapists, occupational therapists as well as medical social workers also helped to formulate the discharge plan as early as the patient is admitted. In conclusion, a well-planned and executed clinical pathway for hip fracture can improve the clinical outcomes of the geriatric hip fractures.
