'Straight to bed' for hip-fracture patients: a prospective observational cohort study of two fast-track systems in 415 hips

Abstract

Delayed time to surgery is associated with an increase in medical complications and delayed rehabilitation for hip-fracture patients. The aim of this study was to evaluate whether an improved fast-tracking system for hip-fracture patients can reduce waiting time to surgery. We included a consecutive series of 415 hip-fracture patients in a prospective cohort study and followed up after 3 months. The control group (n=335) fast-tracked patients from the Accident & Emergency ward (A&E) to the orthopaedic ward and then surgery. The intervention group (n=80) fast-tracked patients directly to the orthopaedic ward and surgery, bypassing the A&E. The time to surgery was mean 3 (95% confidence interval (CI) 1-5) h shorter in the intervention group and 70 patients (88%) underwent surgery within 24h compared to 250 (75%) in the control group (P=0.015). The probability for surgery ≤ 24 h remained in favour of the intervention group after adjustments for several possible confounders. We found no difference in mortality or length of stay between the groups. The incidence of adverse events was lower in the intervention group at 3 months, 28% versus 38%, but did not reach statistical significance (P=0.08). By fast-tracking hip-fracture patients straight to the orthopaedic ward, our clinic was able to decrease the mean time from arrival to start of surgery and the majority of these patients underwent surgery within 24h. We believe that this fast-track system could be used in other hospitals, in both Sweden and abroad.