Bypass: an integrated hip fracture care pathway
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ORIGINAL ARTICLE
Bypass: an integrated hip fracture care pathway Nicholas O’Keeffe 1
&
Martin Kelly 1 & Ara Francis 1 & Jacinta Shields 1 & Peter Keogh 1 & Paddy Kenny 1
Received: 5 November 2019 / Accepted: 5 February 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background The incidence of hip fractures is expected to increase over the coming years, placing a greater burden on limited resources. A high volume of patients is brought to hospitals that do not have the resources necessary to provide definitive care. Optimal care involves a coordinated and integrated system of trauma care. The hip fracture care pathway introduced between a referring peripheral hospital and our institution represents a coordinated multidisciplinary approach to patient care. Aims To describe and report on the outcomes over an 18-month period of the integrated hip fracture care pathway between referring peripheral hospitals and our institution. Methods A retrospective analysis of the prospectively maintained hip fracture database over an 18-month period. Results Between March 2017 and September 2018, 86 consecutive patients were referred to our institution through a new referral pathway. Of these, 69 patients came from the Emergency Department of the referring hospital and 17 arrived via bypass. All 86 patients were managed on a specialist orthopaedic ward. The average length of stay was 4.28 days, with maximum of 13 and minimum of 2 days. Over 84% of patients underwent definitive treatment within 48 h of a diagnosed hip fracture. Discussion The fragmented approach to the management of trauma patients both in a pre-hospital and hospital care setting is a cause for concern. Our integrated hip fracture referral pathway, incorporating bypass of the referring hospital, represents a multidisciplinary care pathway for the management of patients with fractured neck of femur and can have potential benefits including improved patient outcomes, allowing the optimal allocation of resources and providing training opportunities. Keywords Hip fracture . Integrated care pathway . Trauma
Introduction In tandem with many developed countries, population ageing is increasing at a rapid pace in Ireland and is expected to continue to do so. In Europe, the proportion of people aged 80 years or greater is expected to triple by the year 2060. In 2014, the Health Service Executive (HSE) estimated that the number of patients over the age of 65 is approaching upwards of 20,000 per year [1]. In the context of healthcare provision, hip fractures represent an important cause of morbidity in the elderly population and places a significant strain on health service providers with respect to the allocation of limited resources. It is estimated that approximately 3000 people sustain hip fractures each year
* Nicholas O’Keeffe [email protected] 1
Department of Trauma & Orthopaedics, Connolly Hospital Blanchardstown, Dublin, Ireland
in Ireland. The incidence of hip fractures in the Republic of Ireland is expected to further increase in the coming year
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