The Effectiveness of Implementing a Care Pathway for Femoral Neck Fracture in Older People: a Prospective Controlled Before and After Study

Objectives: To investigate whether a care pathway for older hip fracture patients can reduce length of stay while maintaining the quality of clinical care.

Design: Prospective study of patients admitted 12 months before and after implementation of a care pathway for the management of femoral neck fracture. Audit data for corresponding time periods from nearby orthopaedic units was used to control for secular trends.

Setting: Teaching hospital.

Subjects: Patients aged 65 years and over with a femoral neck fracture.

Exclusion Criteria: multiple fractures, fractures due to malignancy, re-fracture, total hip replacement, previously entered into the study, operation performed elsewhere. Three-hundred and ninety-five (99%) and 369 (97%) case records were available for full analysis.

Main Outcome Measures: primary outcome: length of stay on the orthopaedic unit.

Secondary Outcomes: ambulation at discharge, discharge destination, in-hospital complications, 30 day mortality, readmission within 30 days of discharge, post-operative days the patient first sat out of bed and walked.

Results: Mean length of stay increased by 6.5 days (95% confidence interval 3.5-9.5 days, P < 0.0005) in the second period with a significant improvement in ambulation on discharge (odds ratio 1.6, 95% confidence interval 1.0-2.6, P = 0.033) and a trend towards reduction in admission to long term care (odds ratio 0.6, 95% confidence interval 0.3-1.0, P = 0.058).

Conclusions: This care pathway was associated with longer hospital stay and improved clinical outcomes. Care pathways for hip fracture patients can be a useful tool for raising care standards but may require additional resources.