Multidisciplinary integrated care pathway for fractured neck of femur. A prospective trial with improved outcome

Abstract

Admitting patients with fractured neck of femur using fast tracking procedure is well established in over 75% of hospitals in the United Kingdom. A retrospective study on 143 patients admitted using such procedure revealed inadequacies in the system. Although the waiting time in the Accident and Emergency Department (A&E) was reduced, it did not contribute much to the other aspects of patients outcome. We conducted a prospective trial using a multidisciplinary integrated care pathway (ICP) for the management of patients with fractured neck of femur. The objective of this study was to assess the effect of this protocol on the outcome compared to the earlier findings. The outcomes measured were admission time, time to surgery, length of in-hospital stay, cancellations, and 30-day mortality. The results showed a significant reduction in the length of hospital stay (P = 0.001). The 30-day mortality (P = 0.056) and number of patients operated within 24 h of admission were better (P = 0.048) but not significant. There was no difference in the time to admission to orthopaedic ward and other related complications between the two groups. This study has shown that a multidisciplinary care pathway for management of patients with fractured neck of femur has potential benefits.