RESEARCH ARTICLE


The Introduction of a Multidisciplinary Hip Fracture Pathway to Optimise Patient Care and Reduce Mortality: A Prospective Audit of 161 Patients



Michael Shenouda*, Zacharia Silk, Sarkhell Radha, Emer Bouanem, Warwick Radford
Department of Trauma and Orthopaedics, Chelsea & Westminster NHS Foundation Trust, London, UK


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© 2017 Shenouda et al..

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Trauma & Orthopaedics, Chelsea & Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK; Tel: +44 7751 223033; E-mail: m.shenouda@nhs.net


Abstract

Introduction:

Hip fractures are a major cause of morbidity and mortality in the elderly. A new patient pathway was introduced in our institution to facilitate rapid preoperative assessment, acute physician involvement and early surgery for patients with hip fractures. We sought to assess its impact on patient care and outcomes.

Materials and Methods:

Prospective audit of 161 patients admitted with a proximal femoral fracture in the six months before (92 patients) and after (69 patients) implementation of the pathway. Data included: time to orthogeriatric assessment (TtG); time to surgery (TtS); length of hospital stay (LOS); return to original accommodation; inpatient mortality rate.

Results:

In the six months after introduction of the pathway, there was an increase in patients who received pre-operative medical assessment (85% after vs. 19% before, p=0.0001). Average TtG decreased (19 vs. 91 hours, p=0.0001), as did LOS (19.5 vs. 24.8 days, p=0.029) and mortality (4 vs. 14%, p=0.0336). There was an increase in patients returning to their original place of accommodation (80% vs. 57%, p=0.0069). There was a reduction in mean TtS (31 vs. 37 hours, p=0.0663), although this was not statistically significant.

Discussion and Conclusions:

Rapid medical optimisation and prompt surgery significantly improve outcomes in patients with hip fractures. By involving an acute medical team in patient care from the point of admission, we have significantly improved our inpatient mortality and increased the proportion of patients returning to their preoperative place of accommodation, thereby maintaining patient independence and reducing the financial and logistical burden on social care.

Keywords: Audit, Multidisciplinary Care, National Hip Fracture Database, Outcomes, Proximal femoral fracture.