A unified multidisciplinary fragility hip fracture pilot pathway in a trauma centre in Hong Kong: One-year outcome in the acute phase

Introduction: The growing impact of fragility hip fracture (FHF) on the healthcare system and the society has become a major concern worldwide. A unified multidisciplinary FHF pathway from admission to rehabilitation and back to community was established in 2015. The acute phase of the pathway was put into pilot in our hospital to evaluate the outcome. Method: A designated FHF team was established in our centre since January 2015. The FHF pathway was piloted since June 2015. Patients admitted with a hip fracture resulting from fall on standing height were included. Major outcome parameters were compared in three phases: (1) before FHF team and FHF pathway (January to December 2014), (2) after FHF team but before FHF pathway (January to May 2015) and (3) after FHF team and FHF pathway (June 2015 to May 2016). Result: In phases 1, 2 and 3, 631, 263 and 634 patients were included, respectively. From phases 1 to 3, the average key performance indicator (KPI) has improved from 49.2% to 65.8% to 70.0% significantly; average acute length of stay (days) has improved from 13.7 to 13.4 to 11.3 significantly; total surgical complication rates have improved from 6.2% to 7.6% to 5.8%. The 30-day mortality rate and the unplanned readmission rate (within 28 days) have remained below 2.7% and 2.2%, respectively. Conclusions: Implementation of an FHF pathway can form a multidisciplinary platform that can improve the standard of care and outcome for our FHF patients in terms of KPI and also length of stay. New knowledge added by this study: A newly designed and implemented fragility hip fracture pathway in our centre as a pilot with the results evaluated. Implications for clinical practice or policy: With the increasing elderly population in Hong Kong and globally, there is a need to design and implement a fragility hip fracture (FHF) pathway to improve the care and effectiveness for FHF patients.