Resultados en salud tras la implantación de una guía multidisciplinar para la atención a la fractura de cadera

Abstract

Background and objectives: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures. Materials and methods: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the 2 periods studied (June 2015-May 2016 and June 2016-May 2017). Results: The baseline characteristics of the population were similar in the pre-intervention period (n=455) compared to the post-intervention period (n=456). Patients' mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs 15.6 days, p=.014); improved osteoporosis treatment prescribing (51.6% vs 88%, p<.001); and reduced episodes of delirium (44% vs 31.2%, p<.001), bronchospasm (18.3% vs 12%, p=.019), heart failure (20% vs 11.5%, p<.001), and COPD exacerbation (7.9% vs 3.8%, p=.017). We observed an increase in pressure ulcers at discharge (2.9 vs 9%, p<.001). There were no differences in the percentage of operations in less than 48 hours (56% vs 61.2% p=.64), hospital readmissions (6.9% vs 5.9%, p=.51), or mortality (5.0% vs 7.2%, p=.17). Conclusions: The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture.