Room for improvement in the treatment of hip fractures in Denmark.
BACKGROUND
Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records.


METHODS
This was a national multicenter audit of hospital charts from each hospital treating ≥ 50 hip fracture patients per year (n = 594).


RESULTS
The study demonstrated significant variability in treatment and care of patients with hip fractures among the regions of Denmark. Pain management, nutritional screening, ambulation characteristics, training in activities of daily living, and rehabilitation planning were consistently inadequate. Length of stay was 7-11 days.


CONCLUSIONS
Although the principles for fast-track surgery have been adapted to some extent at all departments in Denmark with an annual treatment of at least 50 patients with hip fractures, no single department has implemented the whole package. Hospital stay has been reduced since the introduction of fast-track regimes, and improvements were seen in many of the quality indicators. Implications for future practice include better adherence to clinical guidelines, a more homogeneous documentation system in nursing, promotion of evidence-based standards, and improved treatment and care of the physical and psychological consequences of hospitalization.
The University Hospitals' Centre for Nursing and Care Research, Rigshospitalet, København Ø, Denmark. ie@ucsf.dk
Ingrid
I
Egerod
Kirsten
K
Rud
Kirsten
K
Specht
Pia Søe
PS
Jensen
Anne
A
Trangbaek
Ingerlise
I
Rønfelt
Birte
B
Kristensen
Henrik
H
Kehlet
D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome