title: Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients.
abstract: OBJECTIVE
  Modern management of the elderly with a hip fracture is complex and costly. The aim of this study was to compare the treatment-related hospital length of stay (HLOS) before and after implementing a clinical pathway for patients undergoing hip fracture surgery.
  
  
  METHODS
  This was a retrospective, before-and-after study. The first period ranged from June 21, 2008 to November 1, 2009 (N = 212), and the second was from January 7, 2010 to July 7, 2011 (N = 314). The electronic hospital system and patients records were reviewed for demographics, HLOS, mortality, complications and readmissions.
  
  
  RESULTS
  In the first period 53 % had a femoral neck fracture, of which 57 % were treated with hemiarthroplasty. In the second period this was 46 % and 71 %. Pertrochanteric fractures were treated with a Gamma nail in 85 % in the first period, and in 92 % in the second period. The median HLOS decreased from nine to six days (p < 0.001). For the hemiarthroplasty group HLOS decreased from nine to seven days (p < 0.001); for internal fixation there was no significant difference (five versus six days, p = 0.557) and after Gamma nailing it decreased from ten to six days (p < 0.001). For mortality no statistically significant difference was found (6 % versus 5 %, p = 0.698). Complications decreased for the Gamma nail group (44 % versus 31 %, p = 0.049). Readmissions for the total group were not different (16 % versus 17 %, p = 0.720).
  
  
  CONCLUSIONS
  Implementing a clinical pathway for hip fractures is a safe way to reduce the HLOS and it improves the quality of care.
authors: Department of Surgery, IJsselland Ziekenhuis, 2906 ZC, Capelle aan den IJssel, The Netherlands, p.t.p.w.burgers@erasmusmc.nl.
authors: Paul T P W
authors: PT
authors: Burgers
authors: Esther M M
authors: EM
authors: Van Lieshout
authors: Joost
authors: J
authors: Verhelst
authors: Imro
authors: I
authors: Dawson
authors: Piet A R
authors: PA
authors: de Rijcke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies