Utilidad de una vía clínica en el manejo del anciano con fractura de cadera / Clinical pathway for hip fracture patients

Introducción. La fractura de cadera del anciano se asocia con elevada comorbilidad, por lo que requiere un enfoque integral y multidisciplinar. Objetivo. Evaluar el efecto de una intervención de mejora de calidad en la detección y tratamiento de complicaciones del anciano que ingresa por fractura de cadera. Material y métodos. Estudio comparativo entre dos cohortes de pacientes ingresados por fractura de cadera antes (2010) y después de instaurar una vía clínica (2013). La intervención consistió en la implantación de protocolos para el manejo de los problemas más prevalentes, según la evidencia científica actual y se evaluó el grado de cumplimiento de las medidas implementadas. Resultados. Las características de los pacientes ingresados por fractura de cadera en 2010 (216 pacientes) y 2013 (196 pacientes) fueron similares en edad, sexo, índice de Barthel e índice de Charlson abreviado, aunque con mayor número de comorbilidades en el 2013. Tras la implantación de los protocolos, se incrementó la detección de delirium, desnutrición, anemia y trastornos electrolíticos, aumentando la prescripción de hierro por vía intravenosa (en un 24%) y de tratamiento para la osteoporosis (61,3%). La estancia media se redujo un 45,3% y la demora quirúrgica un 29,4%, consiguiéndose una mejor eficiencia funcional. Conclusión. La aplicación de una vía clínica en el proceso asistencial del paciente geriátrico con fractura de cadera es útil no solo para detectar y tratar de forma precoz las complicaciones sino también para reducir la estancia prequirúrgica y global, todo ello sin repercusión negativa en el aspecto clínico y funcional (AU)

Introduction. Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. Purpose. To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. Material and methods. A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Results. Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. Conclusion. The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact (AU)

[Clinical pathway for hip fracture patients]. / Utilidad de una vía clínica en el manejo del anciano con fractura de cadera.

INTRODUCTION: Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. PURPOSE: To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. MATERIAL AND METHODS: A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. RESULTS: Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. CONCLUSION: The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact.