Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients
Purpose 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 retrospectiv...
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| Veröffentlicht in: | International orthopaedics 2014-05, Vol.38 (5), p.1045-1050 |
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| container_title | International orthopaedics |
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| creator | Burgers, Paul T. P. W. Van Lieshout, Esther M. M. Verhelst, Joost Dawson, Imro de Rijcke, Piet A. R. |
| description | Purpose
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
|
| doi_str_mv | 10.1007/s00264-013-2218-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3997766</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1519260668</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-92b43992ac3e1dfa401d554d1285e624cfeab62ca46f50a09dfce815060cc1453</originalsourceid><addsrcrecordid>eNp9kc2OFCEURonROO3oA7gxLN2UcimgumJiYib-TDKJG10Tmrp0MamCEqiZ6ffwgaXtcaIbV4Rw7vfdcAh5CewNMNa9zYxxJRoGbcM5bBv5iGxAtLyR0MvHZMNaAQ1XvTwjz3K-Zgw6tYWn5IyLtu06CRvy83JeJpwxFB_21FA7-eCtmehiynhrDtTFREe_UJeMLWvC_I6ic2hLpjHQMebFl4pPGPZlpNHRXOqUCQO1sUbXrOIrmEzBTH2gzt8gHdcwJBx-Y-W2lh9o9nfHTl8v-Tl54syU8cX9eU6-f_r47eJLc_X18-XFh6vGCsFL0_OdaPueG9siDM4IBoOUYgC-lai4sA7NTnFrhHKSGdYPzuIWJFPMWhCyPSfvT7nLuptxsLU7mUkvyc8mHXQ0Xv_7Evyo9_FG19auU6oGvL4PSPHHirno2WeL02QCxjVrqCK4YkptKwon1KaYc0L3UANMH23qk01dbeqjTX3c79Xf-z1M_NFXAX4Ccn0Ke0z6Oq4p1D_7T-ovrgmu7w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1519260668</pqid></control><display><type>article</type><title>Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>SpringerLink Journals - AutoHoldings</source><creator>Burgers, Paul T. P. W. ; Van Lieshout, Esther M. M. ; Verhelst, Joost ; Dawson, Imro ; de Rijcke, Piet A. R.</creator><creatorcontrib>Burgers, Paul T. P. W. ; Van Lieshout, Esther M. M. ; Verhelst, Joost ; Dawson, Imro ; de Rijcke, Piet A. R.</creatorcontrib><description>Purpose
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.</description><identifier>ISSN: 0341-2695</identifier><identifier>EISSN: 1432-5195</identifier><identifier>DOI: 10.1007/s00264-013-2218-5</identifier><identifier>PMID: 24337751</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Critical Pathways ; Female ; Hip Fractures - surgery ; Humans ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Original Paper ; Orthopedics ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Retrospective Studies</subject><ispartof>International orthopaedics, 2014-05, Vol.38 (5), p.1045-1050</ispartof><rights>Springer-Verlag Berlin Heidelberg 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-92b43992ac3e1dfa401d554d1285e624cfeab62ca46f50a09dfce815060cc1453</citedby><cites>FETCH-LOGICAL-c442t-92b43992ac3e1dfa401d554d1285e624cfeab62ca46f50a09dfce815060cc1453</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997766/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997766/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24337751$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Burgers, Paul T. P. W.</creatorcontrib><creatorcontrib>Van Lieshout, Esther M. M.</creatorcontrib><creatorcontrib>Verhelst, Joost</creatorcontrib><creatorcontrib>Dawson, Imro</creatorcontrib><creatorcontrib>de Rijcke, Piet A. R.</creatorcontrib><title>Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients</title><title>International orthopaedics</title><addtitle>International Orthopaedics (SICOT)</addtitle><addtitle>Int Orthop</addtitle><description>Purpose
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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Critical Pathways</subject><subject>Female</subject><subject>Hip Fractures - surgery</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Paper</subject><subject>Orthopedics</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><issn>0341-2695</issn><issn>1432-5195</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2OFCEURonROO3oA7gxLN2UcimgumJiYib-TDKJG10Tmrp0MamCEqiZ6ffwgaXtcaIbV4Rw7vfdcAh5CewNMNa9zYxxJRoGbcM5bBv5iGxAtLyR0MvHZMNaAQ1XvTwjz3K-Zgw6tYWn5IyLtu06CRvy83JeJpwxFB_21FA7-eCtmehiynhrDtTFREe_UJeMLWvC_I6ic2hLpjHQMebFl4pPGPZlpNHRXOqUCQO1sUbXrOIrmEzBTH2gzt8gHdcwJBx-Y-W2lh9o9nfHTl8v-Tl54syU8cX9eU6-f_r47eJLc_X18-XFh6vGCsFL0_OdaPueG9siDM4IBoOUYgC-lai4sA7NTnFrhHKSGdYPzuIWJFPMWhCyPSfvT7nLuptxsLU7mUkvyc8mHXQ0Xv_7Evyo9_FG19auU6oGvL4PSPHHirno2WeL02QCxjVrqCK4YkptKwon1KaYc0L3UANMH23qk01dbeqjTX3c79Xf-z1M_NFXAX4Ccn0Ke0z6Oq4p1D_7T-ovrgmu7w</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Burgers, Paul T. P. W.</creator><creator>Van Lieshout, Esther M. M.</creator><creator>Verhelst, Joost</creator><creator>Dawson, Imro</creator><creator>de Rijcke, Piet A. R.</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140501</creationdate><title>Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients</title><author>Burgers, Paul T. P. W. ; Van Lieshout, Esther M. M. ; Verhelst, Joost ; Dawson, Imro ; de Rijcke, Piet A. R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-92b43992ac3e1dfa401d554d1285e624cfeab62ca46f50a09dfce815060cc1453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Critical Pathways</topic><topic>Female</topic><topic>Hip Fractures - surgery</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Paper</topic><topic>Orthopedics</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burgers, Paul T. P. W.</creatorcontrib><creatorcontrib>Van Lieshout, Esther M. M.</creatorcontrib><creatorcontrib>Verhelst, Joost</creatorcontrib><creatorcontrib>Dawson, Imro</creatorcontrib><creatorcontrib>de Rijcke, Piet A. R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burgers, Paul T. P. W.</au><au>Van Lieshout, Esther M. M.</au><au>Verhelst, Joost</au><au>Dawson, Imro</au><au>de Rijcke, Piet A. R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients</atitle><jtitle>International orthopaedics</jtitle><stitle>International Orthopaedics (SICOT)</stitle><addtitle>Int Orthop</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>38</volume><issue>5</issue><spage>1045</spage><epage>1050</epage><pages>1045-1050</pages><issn>0341-2695</issn><eissn>1432-5195</eissn><abstract>Purpose
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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>24337751</pmid><doi>10.1007/s00264-013-2218-5</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | International orthopaedics, 2014-05, Vol.38 (5), p.1045-1050 |
| issn | 0341-2695 1432-5195 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3997766 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; SpringerLink Journals - AutoHoldings |
| subjects | Aged Aged, 80 and over Critical Pathways Female Hip Fractures - surgery Humans Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Original Paper Orthopedics Postoperative Complications - epidemiology Postoperative Complications - etiology Retrospective Studies |
| title | Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients |
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