Efficiency of the lausanne clinical pathway for proximal femoral fractures.
Efficiency of the lausanne clinical pathway for proximal femoral fractures.
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DOI：
10.3389/fsurg.2015.00005
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发表时间：
2015
影响因子：
1.8
通讯作者：
Jolles BM
中科院分区：
文献类型：
--
作者：
Fleury N;Chevalley F;Rubli E;Coti P;Farron A;Jolles BM
目的/导言：由于预期寿命的增加，髋部骨折的数量正在上升。在这种情况下，患者面临术后并发症的风险，因此平均住院时间可能会延长。2011年，我们建立了临床路径(CP)，这是一种针对患者护理管理的特定护理模式，旨在改善老年患者股骨近端骨折治疗的临床和经济结果。目标是使用临床、过程和财务指标来评估CP。方法：我们纳入了所有65岁及以上的外科患者，他们因跌倒导致股骨近端骨折而进入急诊科。评估参数包括三个绩效指标：临床、过程和财务。临床指标为术后第三天有无急性精神错乱、院内肺炎的诊断以及住院期间结束时满足至少75%营养需求的患者数量。过程指标是到达急诊科和手术之间的时间间隔。财务指标是根据住院天数计算的。结果：2011-2013年间，共有669例患者纳入CP。我们观察到，一旦实施CP，平均住院时间就减少了，然后稳定下来。2013年，90%的患者在到达急诊室后48 小时内接受手术的目标(93.1%)被超过。此外，我们还观察到临床指标的改善。结论：在临床、过程和经济因素方面，CP的应用提高了老年患者股骨近端骨折治疗的定性和定量效率。
Purpose/Introduction: The number of hip fractures is rising, due to increases in life expectancy. In such cases, patients are at risk from post-operative complications and subsequently the average length of hospitalization may be extended. In 2011, we established a clinical pathway (CP), a specific model of care for patient-care management, to improve the clinical and economic outcomes of proximal femoral fracture management in elderly patients. The goal was to evaluate the CP using clinical, process, and financial indicators. Methods: We included all surgical patients aged 65 and over, admitted to the emergency department with a fracture of the proximal femur following a fall. Assessment parameters included three performance indicators: clinical, process, and financial. The clinical indicators were the presence or absence of acute delirium on the third post-operative day, diagnosis of nosocomial pneumonia, and the number of patients fulfilling at least 75% of their nutritional requirements at the end of the hospitalization period. The process indicator was the time interval between arrival at the emergency department and surgery. The financial indicator was based on the number of days spent in hospital. Results: From 2011 to 2013, 669 patients were included in the CP. We observed that the average length of stay in hospital decreased as soon as the CP was implemented and stabilized afterwards. The goal of 90% of patients undergoing surgery within 48 h of arrival in the emergency department was surpassed in 2013 (93.1%). Furthermore, we observed an improvement in the clinical indicators. Conclusion: The application of a CP allowed an improvement in the qualitative and quantitative efficiency of proximal femoral fracture management in elderly patients, in terms of clinical, process, and financial factors.