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 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.

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