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Education, Teaching, and Quality Improvement |

Evidence-Based Clinical Pathway Improves Outcomes in Patients With Isolated Hip Fracture

Amy Pate; Akella Chendrasekhar
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Richmond University Medical Center, Staten Island, NY


Chest. 2014;146(4_MeetingAbstracts):553A. doi:10.1378/chest.1988235
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Abstract

SESSION TITLE: Cost and Quality Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Hip fractures are a common cause of morbidity and mortality in elderly patients. We developed an evidence-based multidisciplinary pathway requiring that all patients with hip fracture be admitted to the trauma service and undergo bleeding risk assessment in addition to other optimal care practices. The purpose of this study is to determine whether the implementation of an evidence-based clinical pathway affects outcome in patients with isolated hip fracture.

METHODS: We conducted an observational study of all patients with isolated hip fracture admitted to a level-I urban teaching hospital. Data was collected retrospectively from January 2012 to December 2013; the pathway was implemented in July 2013. Medical records were reviewed for patient demographics, injury severity score (ISS), time from admission to operative intervention, length of stay (LOS), and survival to discharge. Statistical analysis was performed using chi-square analysis or t-test as appropriate.

RESULTS: A total of 105 patients, 40 males and 65 females, with a mean age of 77.9 ± 2.9 years were included. Mean ISS was 9.743 ± 0.581, mean LOS was 6.61 ± 0.422 days, and mean time to operative intervention was 1.648 ± 0.129 days. Overall mortality was 4.8% (n=5). There were 58 patients identified prior to implementation of the pathway and 47 patients identified after implementation of the pathway. Mean ISS, age, and time to operation did not significantly vary across the two groups. Mean LOS was lower after implementation of the pathway (7.121 ± 0.611 d vs. 5.979 ± 0.535 d, p=0.007). Implementation of the pathway was correlated with survival to discharge (p=0.039)

CONCLUSIONS: Implementation of an evidence-based clinical hip fracture pathway is associated with reduced LOS and survival to discharge. Further large-scale research is necessary to determine the accuracy of these findings.

CLINICAL IMPLICATIONS: The utilization of an evidence-based multidisciplinary clinical pathway may significantly improve outcome in patients with isolated hip fracture.

DISCLOSURE: The following authors have nothing to disclose: Amy Pate, Akella Chendrasekhar

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