Hip fractures in older patients: analysing the activity of an orthopaedic department to design an optimized pathway of fracture care

Abstract

Summary

Substandard management of hip fractures in older patients has serious consequences in outcomes. Assessing care provided and institutional characteristics is essential to identify aspects to improve for better results. Delay to surgery, inadequate pain management, and delay in urinary catheter removal were especially inadequate and needed correction to better patient recovery.

Introduction

Hip fractures in older patients are a public health issue due to their prevalence and consequences. This study is an assessment of treatment currently provided to older patients with hip fractures in a tertiary hospital as a way of measuring standard care and guiding the design of a hospital-specific care pathway for the treatment of these patients.

Methods

A total of 250 patients over 65 years old were analysed. The overall population and its subgroups (early or late surgery and admitted to orthopaedic or non-orthopaedic ward) were characterized through descriptive statistical analysis, and the results were compared through inferential and regression analysis.

Results

Aspects requiring improvement were identified: inadequate pain management in the emergency department, increased time to surgery, excessive length of stay, increased time to first ambulation and to urinary catheter removal, medical complications and decrease in functional capacity at discharge. The mortality rate at discharge and up to 6 months was similar to what is described in the literature, in spite of the issues identified. Although further analysis is needed, some empirical reasons for these results are proposed.

Discussion

Some of the results described can be attributed to common hospital characteristics or non-modifiable patient characteristics but others can be corrected by suitable interventions.