Clinical pathway for fractured neck of femur: a prospective, controlled study

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Abstract
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.