title: [Clinical pathway for hip fracture patients].
abstract: BACKGROUND
  Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach.
  
  
  OBJECTIVE
  To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture.
  
  
  METHODS
  A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified.
  
  
  RESULTS
  Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency.
  
  
  CONCLUSIONS
  The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact.
authors.affiliation: Unidad de Geriatría, Complejo Asistencial de Ávila, Ávila, España. Electronic address: pisalop@gmail.com.
authors.forename: Pilar
authors.initials: P
authors.lastname: Sáez López
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España.
authors.forename: Natalia
authors.initials: N
authors.lastname: Sánchez Hernández
authors.affiliation: Servicio de Medicina Preventiva, Hospital Río Hortega, Valladolid, España.
authors.forename: Sonsoles
authors.initials: S
authors.lastname: Paniagua Tejo
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Valverde García
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España.
authors.forename: Margarita
authors.initials: M
authors.lastname: Montero Díaz
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España.
authors.forename: Noelia
authors.initials: N
authors.lastname: Alonso García
authors.affiliation: Servicio de Cardiología. Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Freites Esteve
mesh_terms: D000369:Aged, 80 and over; D019091:Critical Pathways; D005260:Female; D006620:Hip Fractures / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male
keywords: Anciano; Asistencia hospitalaria; Complicaciones; Complications; Elderly; Fractura de cadera; Hip fracture; Hospital care