Clinical pathway for fractured neck of femur: a prospective, controlled study.
OBJECTIVE
To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur.


METHODS
Prospective, pseudorandomised, controlled trial.


METHODS
St Vincent's Hospital, Melbourne, Victoria (a tertiary referral, university teaching hospital), 1 October 1997 to 30 November 1998.


METHODS
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.


METHODS
Management guided by a clinical pathway (55 patients) or established standard of care (control group, 56 patients).


METHODS
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).


CONCLUSIONS
Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications.
Choong
P F
PF
Department of Orthopaedics, St Vincent's Hospital, Melbourne, Vic. PeterChoong@c031.aone.net.au
Langford
A K
AK
Dowsey
M M
MM
Santamaria
N M
NM
D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation; D016896:Treatment Outcome