[Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital].
OBJECTIVE
To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome.


METHODS
A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified.


RESULTS
The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway.


CONCLUSIONS
The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes.
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España. Electronic address: natalia37004@hotmail.com.
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N
Sánchez-Hernández
Geriatra, Complejo Asistencial de Ávila, Ávila, España.
P
P
Sáez-López
Medicina Preventiva, Hospital Universitario Río Hortega , Valladolid, España.
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S
Paniagua-Tejo
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Ávila, Ávila, España.
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JA
Valverde-García
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D058866:Osteoporotic Fractures / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data*; D020127:Recovery of Function; D063728:Secondary Care Centers; D055502:Secondary Prevention; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
Anciano; Clinical pathway; Elderly; Estancia hospitalaria; Estancia prequirúrgica.; Fractura de cadera; Hip Fracture; Length of stay; Time to surgery.; Vía clínica