'Making a difference' a clinical pathway for hip fractures and the advance practice role in managing patients with minimal trauma hip fractures
Faculty of Health, Engineering and Science
School of Nursing and Midwifery
Background: In 2006/2007 there were estimated over 16,500 patients with hip fractures in Australia, the majority (94%) were over 65 years. Patients with hip fractures nearly always require hospitalisation and surgery. Aim: The aim of this study was to assess the impact of the hip fracture clinical pathway on care of the hip fracture patient. Method: This study is a retrospective medical record audit of all minimal trauma hip fracture patients over 65 years in a large tertiary hospital over a three month period before and after implementation of the hip fracture clinical pathway. Results: For patients in the intervention group (. n = 28, mean 86.0 years) compared with the control group (. n = 33, mean 85.7 years) time to surgery was <24-h (92.9% vs. 51.5%, p = 0.001), the venous thromboembolism (VTE) risk assessment form was completed (21.4% vs. 0%, p = 0.004), VTE prophylaxis improved, fewer patients received no prophylaxis (0% vs. 33.3%, p = 0.001), pharmacological prophylaxis only (21.4% vs. 54.4%, p = 0.008) and more patients received pharmacological prophylaxis and graduated compression stockings (75.0% vs. 12.1%, p = 0.001) and were discharged with osteoporosis treatment calcium and vitamin D (35.7% vs. 6.1%, p = 0.008). Conclusion: Implementation of the hip fracture clinical pathway improved time to surgery (<24 h), VTE risk assessment and prophylaxis, and osteoporosis treatment on discharge.