Clinical pathway of hip fracture management

Abstract

The team started work in August 2006. With active participation and involvement of multidisciplinary members, the clinical pathway appropriate to the Hong Kong situation from acute to convalescent phases was mapped out. As the service scope covers 3 hospitals in our region � Queen Mary Hosptial (QMH), Fung Yiu King Hospital (FYKH) and MacLehose Medical Rehabilitation Centre (MMRC), with the concerted effort of team members from all three hospitals, the clinical pathway was then worked spanning across 3 hospitals so that patients could be assured of the quality and continuity of care. The pathway was finalized in Jan 2007 and pilot run in February 2007. MAJOR ACHIEVEMENTS1.Reduce Length of Stay (LOS) The team has identified room for improvement in the 4 days average pre-operation length of stay. With the support from anesthetists and fellow trauma surgeons, the average pre-operation length of stay was reduced to 2 days in 2007. The total length of stay has also been reduced from 12 days to 7 days (- 34%) over the last one year. Detailed result and comparison with Hospital Authority (HA) average through cluster wide collaboration between acute hospital (QMH), and 2 convalescence hospitals (FYKH/MMRC) achieved are listed as follows:Pre-op LOS <=2 days: 2006: HA: 34%; QMH: 15%2007 (Jan-Aug): HA: 40%; QMH: 48% 2007 (Sep): HA 53%: QMH:70%2007 (Nov): HA 58%; QMH: 82% Total LOS:2006: 12.07 days2007 (Feb �May): 9.77 days2007 (Jun � Aug): 8.14 days2007 (Sep � Dec): 7.27 daysLOS (convalescence):2006: 40 days2007(Feb � May): 34 days2007(Jun � Aug): 33 days2007(Sep-Dec): 26 days2. Better Quality Care to patientsWith the structured clinical pathway, the expected length of stay, details of the rehabilitation program and general expected outcome of recovery after hip fractures can be communicated to the patient, their family/ care provider at the early stage of the admission. �Fall Prevention Program� has been added to the standard care process to enable patients and families to improve their self care ability. Osteoporosis management program was also incorporated into the hip fracture pathway to prevent future osteoporotic induced problems.3. Teamwork & Common Vision The clinical pathway established by the team has its uniqueness in that it starts from acute hospital and continues at convalescence hospital till patient discharge. Flow of information and continuity of patient management between acute and convalescence hospitals are strengthened throught enhanced multidisciplinary and intra cluster collaboration and communication.4. Resource ManagementThe team has mobilized every resource available within the hospitals and in the community. Apart from appointing a part time nurse as case manager, volunteer service group was recruited for extending the service. WAYS FORWARD:The team has achieved the objective of enhancing quality care to fracture hip patients through effective collaboration between different disciplines and hospitals. It will not be a success without the ommitment, teamwork, mutual understanding and common vision for better patient care from all the team members.