Fractured neck of femur patient care improved by simulated fast-track system

Journal of Orthopaedics and Traumatology

Michael Swart¹  Rachel Blackshaw¹  Andrew Fordyce¹  Robert A. Lofthouse¹  Jonathan D. Kosy¹ 

[1] Torbay Hospital$$

关键词: Optimisation;   

DOI  :  10.1007/s10195-013-0240-4

学科分类：骨科学

来源: Springer

【 摘 要 】

Background

Fractured neck of femur patients represent a large demand on trauma services, and timely management results in improvements in morbidity and mortality. NICE guidance, advocating surgery on the day of admission or the following day, emphasises this. We set out to investigate whether a simulated fast-track management system could improve neck of femur fracture patient care.

Materials and methods

This prospective study was performed in a district general hospital in South West England, following a change in practise. We studied 429 patients over a 1-year period. Patients were phoned through, by the ambulance crew, to a trauma coordinator who arranged prompt radiological assessment and review. Patients with confirmed fractures were transferred to an optimisation area for orthopaedic and anaesthetic assessment prior to surgery the same day or early the following day. Our primary outcome measures were time to theatre (h) and length of hospital stay (days/h).

Results

Time to theatre reduced from 44.95 (±27.42) to 29.28 (±21.23) h. Length of stay reduced from 10 days (245.92 (±131.02) h) to 9 days (225.30 (±128.75) h). Both of these improvements were statistically significant (P < 0.05). Despite operating on virtually all patients, no increase in adverse events was seen, there was no increase in 30-day mortality and there were no perioperative deaths.

Conclusions

This coordinated management pathway improves the efficiency of the service and reduces inpatient length of stay. Increased productivity may lead to financial savings and improve our ability to meet guidelines.

【 授权许可】

Unknown