Evaluation of the Implementation of a Multidisciplinary Fast Track Program for Geriatric Acute Hip Fracture Patients at a University Hospital in Resource-Limited Settings

Background: Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes. Methods: A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital pre- and post-implementation of the Fast-track program. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation. Results: 302 patients were enrolled from the Siriraj hospital’s database between October 2016 and October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p<0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-hours (80.3% VS 44.7%, p<0.001) and the length of stay was significantly shorter (11 days (8-17) VS 13 days (9-18), p=0.017). There was no significant difference in medical complications and mortality. Stratified analysis by dementia status showed a trend in delirium reduction in both demented and non-demented groups, and a pressure injury reduction among patients with dementia after the program was implemented but there was no statistical significance. Conclusions: The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited settings. In the Fast-track system, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.