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Two admission pathways for elderly patients with hip fracture: clinical outcomes at a single institution

Background:The incidence of hip fractures increases exponentially after the age of 65, and that number will continue to rise over the coming decades as the population ages. In an attempt to provide better patient care for elderly patients with hip fractures and multiple co-morbidities, some centers have created various forms of shared-responsibility services, multidisciplinary care teams, or hospitalist models of care for these patients. The purpose of this study was to examine the clinical outcomes of two different admission pathways for elderly patients with hip fractures. Methods:We conducted a retrospective review of 389 consecutive patients 65 yr of age and older with the diagnosis of a low-energy hip fracture between January 2006 and May 2010 at a single institution. Patients who presented to the study institution before October 2008 were admitted to either the orthopaedic surgery or the internal medicine service (old pathway, OP). Beginning in October 2008, all elderly patients with a low-energy hip fracture were admitted to the internal medicine service with a more structured, uniform clinical pathway in place (new pathway, NP). We evaluated differences in perioperative complication rates, readmission rates, time to surgery (TTS), and length of hospital stay (LOS) between the two pathways. Results:There were no significant differences in LOS, TTS, 30-day re-admission rates, rapid response codes, perioperative complications or death between the care models. The NP did demonstrate a significant increase in blood product transfusions over the OP (51.85% compared with 36.56%, respectively) and the number of patients diagnosed with vitamin D deficiency (42.12% compared with 20.70%, respectively). Conclusions:While our change in protocol did not alter the rate of perioperative complications, TTS, readmissions rates, or LOS it did provide more comprehensive osteoporosis care to our patients.