Clinical Pathway for Fractured Neck of Femur: A Prospective, Controlled Study

Med J Aust. 2000 May 1;172(9):423-6.

Abstract

Objective: To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur.

Design: Prospective, pseudorandomised, controlled trial.

Setting: St Vincent's Hospital, Melbourne, Victoria (a tertiary referral, university teaching hospital), 1 October 1997 to 30 November 1998.

Participants: 111 patients (80 women and 31 men; mean age, 81 years) admitted via the emergency department with a primary diagnosis of fractured neck of femur.

Interventions: Management guided by a clinical pathway (55 patients) or established standard of care (control group, 56 patients).

Main outcome measures: Timing of referrals and discharge planning; total length of stay; and complication and readmission rates within 28 days of discharge.

Results: Patients managed according to the clinical pathway had a shorter total stay (6.6 versus 8.0 days; P = 0.03), even if assessment for placement by the Aged Care Assessment Service was required (9.5 versus 13.6 days; P = 0.03). There were no significant differences in complication and readmission rates between pathway and control patients (complication rates, 24% versus 36%; P = 0.40; readmission rates, 4% versus 11%; P = 0.28).

Conclusion: Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Critical Pathways*
  • Female
  • Femoral Neck Fractures / complications
  • Femoral Neck Fractures / therapy*
  • Humans
  • Length of Stay / statistics & numerical data*
  • Linear Models
  • Male
  • Prospective Studies
  • Referral and Consultation
  • Treatment Outcome