Improving the Treatment for Hip Fracture in The Elderly Patients at Thungsong Hospital, Nakhon Sri Thammarat
Keywords:
Elderly patients, Hip fracture, treatment, Thung songAbstract
Introduction : Hip fractures are common injuries in the older persons and are associated with morbidity and mortality. Nowadays the incidence of hip fractures is increasing. The department of orthopedic surgery at Thungsong hospital aims to improve the treatment. On May 2015, the annual meeting
“the manual of care in elderly patients with hip fracture” was held at Thungsong hospital.
Objectives : To compare the results of the standard treatment that the patients received before the meeting with those of the standard treatment that they receive after the meeting.
Materials and methods : The study was designed as a cross-sectional study. The charts of patients aged over 60 years old who were admitted from January 2013 to December 2016 were reviewed. The patients were divided into two groups.
Group 1 : The patients who received the treatment before the annual meeting (1 January 2013 to 31 May 2015)
Group 2 : The patients who received the treatment after the annual meeting (1 June 2015 to 31 December 2016)
The standard treatment criteria were used to compare : the time to ward within 4 hours, the time to surgery within 48 hours, preoperative assessment by medicine, rehabilitation assessment, receiving deep vein thrombosis prophylaxis (DVT), falls assessment, treatment osteoporosis, patients developing complication (pressure ulcer, urinary tract infection), decrease length of hospital stay and readmission within 30 days.
Results : There were 181 patients, 67 patients in group 1 and 114 patients in group 2.The ratio of females to males was 3:1. The age between 80 and 89 years old accounted for the majority. The Intertrochanteric fractures were common (62% in group 1, 58% in group 2). 24% patients in group 1 were surgery and 34% patients in group 2 were surgery. Group 2 patients had the improving the treatment, the time to surgery was decrease from mean 6 to 4 days, the surgery within 48 hours was increase from 31% to 38%, the medical prophylaxis for DVT was increase 7%, the pressure ulcer wound was decrease, the urinary tract infection after hip fracture was decrease and the hospital stay was decrease from mean 12 to 8 days. Unfortunately, the time to ward was increase from mean 1.7 to 2.3 hours and the admission to orthopedic ward within 4 was decrease in group 2.
Discussion and conclusions : Improvements in the quality of hip fracture treatment after the annual meeting on May 2015 were found. However some criteria were not achieved. The next step of the annual meeting will be further developed in order to better improve the treatment
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