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Protocol-based interdisciplinary co-management for hip fracture care: 3 years of experience at an academic medical center

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Abstract

Background

Interdisciplinary standardized protocols for the care of patients with hip fractures have been shown to improve outcomes. A hip fracture protocol was implemented at our institution to standardize care, focusing on emergency care, pre-operative medical management, operative timing, and geriatrics co-management. The aim of this study was to evaluate the efficacy of this protocol.

Methods

We conducted a retrospective review of adult patients admitted to a single tertiary care institution who underwent operative management of a hip fracture between July 2012 and March 2020. Comparison of patient characteristics, hospitalization characteristics, and outcomes were performed between patients admitted before and after protocol implementation in 2017.

Results

A total of 517 patients treated for hip fracture were identified: 313 before and 204 after protocol implementation. Average age, average Charlson Comorbidity Index, percent female gender, and distribution of hip fracture diagnosis did not vary significantly between groups. There was a significant reduction in time from admission to surgical management, from 37.0 ± 47.7 to 28.5 ± 27.1 h (p = 0.0016), and in the length of hospital stay, from 6.3 ± 6.5 to 5.4 ± 4.0 days (p = 0.0013). The percentage of patients whose surgeries were performed under spinal anesthesia increased from 12.5 to 26.5% (p = 0.016). There was no difference in 90-day readmission rate or mortality at 30 days, 90 days, or 1 year between groups.

Conclusion

With the implementation of an interdisciplinary hip fracture protocol, we observed significant and sustained reductions in time to surgery and hospital length of stay, important metrics in hip fracture management, without increased readmission or mortality. This has implications to minimize health care costs and improve outcomes for our aging population.

Level of evidence

III, therapeutic.

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Change history

  • 10 March 2021

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Funding

No external funding was received for this research.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave MU 320-W, San Francisco, CA, 94143, USA

    Heather J. Roberts, Derek T. Ward & Utku Kandemir

  2. Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA

    Stephanie E. Rogers

Authors
  1. Heather J. Roberts
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  2. Stephanie E. Rogers
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Contributions

HJR: contributed to study design, data analysis, data interpretation, and writing; SER: contributed to study inception, data interpretation, and critical revision; DTW: contributed to study inception, study design, data interpretation, and critical revision; UK: contributed to study inception, data interpretation, and critical revision.

Corresponding author

Correspondence to Utku Kandemir.

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Conflict of interest

Derek Ward is a paid consultant for Johnson & Johnson (DePuy). The other authors have no financial conflicts of interest to disclose.

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Institutional review board approval was obtained from our institution.

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Roberts, H.J., Rogers, S.E., Ward, D.T. et al. Protocol-based interdisciplinary co-management for hip fracture care: 3 years of experience at an academic medical center. Arch Orthop Trauma Surg 142, 1491–1497 (2022). https://doi.org/10.1007/s00402-020-03699-7

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  • DOI: https://doi.org/10.1007/s00402-020-03699-7

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