EFFECT OF HOSPITAL PROTOCOL IMPLEMENTATION, ENFORCEMENT, AND PERFORMANCE IMPROVEMENT TRACKING ON OUTCOMES IN HIP FRACTURE PATIENTS
Journal Title: IJSR-International Journal Of Scientific Research - Year 2019, Vol 8, Issue 5
Abstract
Introduction: Hip fractures are increasingly common injuries encountered by trauma surgical services. Risk of morbidity and mortality associated with such injuries may be dependent on the standardization of clinical care. Our institution sought to standardize the clinical care of hip fracture patients and created, implemented then enforced an algorithmic hip fracture management protocol. The goal of this study is to analyze outcomes of patients before and after utilization of a hip fracture management protocol. Methods: We retrospectively analyzed 445 hip fracture patients hospitalized for over 24 hours at an urban level 1 trauma center from 2013-2018. We abstracted demographics, injury severity score (ISS), time to operative fixation, hospital length of stay (LOS), intensive care unit LOS, ventilator days, deep venous thrombosis (DVT) prophylaxis appropriateness and survival to hospital discharge. The sample was stratified into three groups and compared based on timing and status of the hip fracture management protocol: A: Antecedent events/no protocol from 1/1/2013–8/1/2014 B: Protocol implemented with no enforcement from 8/2/2014–8/1/2017 C: Protocol continued implementation with enforcement and performance improvement tracking from 8/2/2017- 3/31/2018 Results: Mean time to operative fixation in hours decreased across the time periods: 86.3±3.8 in group A, 48.0±1.1 in group B and 31.1±1.8 in group C (p<0.0001). Mean hospital LOS in days also decreased: 10.4±0.9 in group A, 7.4±0.3 in group B and 5.5±0.4 in group C (p<0.0001). Mean DVT prophylaxis appropriateness (1 = yes; 0 = no) achieved near perfection after protocol implementation: 0.8±0.02 in group A, 1.0±0.006 in group B and 1.0±0.009 years in group C (p<0.0001). Mean fraction of survival to hospital discharge improved after protocol implementation: 0.9±0.02 in group A, 0.99±0.007 in group B and 0.98±0.01 in group C (p=0.0203). Conclusion: Implementation of an organized hip fracture management protocol with enforcement and performance improvement tracking shortens time to operative fixation, increases VTE prophylaxis appropriateness, decreases LOS and increases rate of survival to discharge.
Authors and Affiliations
Gerard A. Baltazar DO FACOS, Kristy A. Fisher MS-4, Krishna Akella DO, Akella Chendrasekhar MD FACS FCCP
Keywords
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