title: Fractured neck of femur patient care improved by simulated fast-track system.
abstract: BACKGROUND
  Fractured neck of femur patients represent a large demand on trauma services, and timely management results in improvements in morbidity and mortality. NICE guidance, advocating surgery on the day of admission or the following day, emphasises this. We set out to investigate whether a simulated fast-track management system could improve neck of femur fracture patient care.
  
  
  METHODS
  This prospective study was performed in a district general hospital in South West England, following a change in practise. We studied 429 patients over a 1-year period. Patients were phoned through, by the ambulance crew, to a trauma coordinator who arranged prompt radiological assessment and review. Patients with confirmed fractures were transferred to an optimisation area for orthopaedic and anaesthetic assessment prior to surgery the same day or early the following day. Our primary outcome measures were time to theatre (h) and length of hospital stay (days/h).
  
  
  RESULTS
  Time to theatre reduced from 44.95 (±27.42) to 29.28 (±21.23) h. Length of stay reduced from 10 days (245.92 (±131.02) h) to 9 days (225.30 (±128.75) h). Both of these improvements were statistically significant (P < 0.05). Despite operating on virtually all patients, no increase in adverse events was seen, there was no increase in 30-day mortality and there were no perioperative deaths.
  
  
  CONCLUSIONS
  This coordinated management pathway improves the efficiency of the service and reduces inpatient length of stay. Increased productivity may lead to financial savings and improve our ability to meet guidelines.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Torbay Hospital, Lawes Bridge, Torquay, TQ2 7AA, UK. jonkosy@yahoo.co.uk
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Kosy
authors.forename: Rachel
authors.initials: R
authors.lastname: Blackshaw
authors.forename: Michael
authors.initials: M
authors.lastname: Swart
authors.forename: Andrew
authors.initials: A
authors.lastname: Fordyce
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lofthouse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000458:organization & administration / Q000592:standards; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards; D004739:England / Q000453:epidemiology; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity; D019637:Orthopedic Procedures / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011859:Radiography; D061665:Time-to-Treatment / Q000458:organization & administration / Q000592:standards
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