Clinical pathway for fractured neck of femur: a prospective, controlled study
Clinical pathway for fractured neck of femur: a prospective, controlled study
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DOI：
10.5694/j.1326-5377.2000.tb124038.x
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发表时间：
2000-05-01
影响因子：
11.4
通讯作者：
Santamaria, NM
中科院分区：
文献类型：
--
作者：
Choong, PFM;Langford, AK;Santamaria, NM
目的：评价采用临床路径治疗股骨颈骨折的疗效。设计：前瞻性、伪随机、对照试验。工作地点：维多利亚州墨尔本圣文森特医院（三级转诊医院，大学教学医院），1997年10月1日至1998年11月30日。参与者：111例患者（80名女性和31名男性，平均年龄81岁）通过急诊科入院，初步诊断为股骨颈骨折。干预措施：按照临床路径进行管理（55例）或建立标准护理（对照组，56例）。主要衡量指标：转诊时间和出院计划；总逗留时间；出院28天内的并发症和再入院率。结果：根据临床路径管理的患者总住院时间较短（6.6天对8.0天，P = 0.03），即使需要进行老年护理评估服务的安置评估（9.5天对13.6天，P = 0.03）。通路组和对照组患者的并发症和再入院率无显著差异（并发症发生率24% vs 36%； P = 0.40；再入院率4% vs 11%； P = 0.28）。结论：多学科协调治疗股骨颈骨折可减少住院时间，且不增加并发症。
Objective: To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur.Design: Prospective, pseudorandomised, controlled trial.Setting: St Vincent's Hospital, Melbourne, Victoria (a tertiary referral, university teaching hospital), 1 October 1997 to 30 November 1998.Participants: 111 patients (80 women and 31 men; mean age, 81 years) admitted via the emergency department with a primary diagnosis of fractured neck of femur.Interventions: Management guided by a clinical pathway (55 patients) or established standard of care (control group, 56 patients).Main outcome measures: Timing of referrals and discharge planning; total length of stay; and complication and readmission rates within 28 days of discharge.Results: Patients managed according to the clinical pathway had a shorter total stay (6.6 versus 8.0 days; P = 0.03), even if assessment for placement by the Aged Care Assessment Service was required (9.5 versus 13.6 days; P = 0.03). There were no significant differences in complication and readmission rates between pathway and control patients (complication rates, 24% versus 36%; P = 0.40; readmission rates, 4% versus 11%; P = 0.28).Conclusion: Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications.