Poor adherence to guidelines in treatment of fragile and cognitively impaired patients with hip fracture: a descriptive study of 2,804 patients.
Background and purpose — Following a hip fracture, most patients will encounter poorer functional outcomes and an increased risk of death. Treatment-monitoring of hip fracture patients is in many countries done by national audits. However, they do not allow for a deeper understanding of treatment li...
| Publicado en: | Acta Orthopaedica Vol. 92; no. 5; pp. 544 - 551 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Medical Journals Sweden AB
Oct 2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=153045366&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 153045366 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17453674 1BVL jtl: Acta Orthopaedica issn: 17453674 maglogo: N pubinfo: dt: Oct 2021 vid: 92 iid: 5 pid: 59195 pub: Medical Journals Sweden AB artinfo: ui: 153045366 153045366 153045366 10.1080/17453674.2021.1925430 153045366 ppf: 544 ppct: 7 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Poor adherence to guidelines in treatment of fragile and cognitively impaired patients with hip fracture: a descriptive study of 2,804 patients. aug: au: Frandsen, Christina F Glassou, Eva N Stilling, Maiken Hansen, Torben B affil: University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Regional Hospital West Jutland sug: subj: Guideline Adherence Evaluation Cognition Disorders Psychiatric Patients Hip Fractures Surgery Descriptive Research Functional Status Treatment Outcomes Mortality Risk Factors Monitoring, Physiologic Audit Patient Admission Length of Stay Patient Discharge Nerve Block Treatment Delay Antibiotics Orthopedic Fixation Devices Venous Thromboembolism Prevention and Control Physical Mobility Blood Transfusion Nursing Home Residents Comorbidity Human Male Female Aged Aged, 80 and Over Aged: 65+ years Aged, 80 & over Male Female ab: Background and purpose — Following a hip fracture, most patients will encounter poorer functional outcomes and an increased risk of death. Treatment-monitoring of hip fracture patients is in many countries done by national audits. However, they do not allow for a deeper understanding of treatment limitations. We performed a local evaluation study to investigate adherence to 7 best-practice indicators, and to investigate patient groups at risk of suboptimal treatment. Patients and methods — 2,804 patients were surgically treated for a hip fracture from 2011 to 2017 at our institution. Data regarding admission, hospital stay, and discharge was prospectively collected, and adherence to the 7 best practice indicators (nerve block, surgical delay, antibiotics, implant choice, thromboprophylaxis, mobilization, and blood transfusions) was analyzed. Patient groups with lower adherence were identified. Results — 34% of patients received all 7 best practice indicators after considering contraindications; in particular, nerve blocks and thromboprophylaxis displayed low adherence at 61% and 91% respectively. Nursing home residents and patients with cognitive impairment, multiple comorbidities, or low functional levels were at risk of having a lower adherence. Interpretation — The most dependent patients with cognitive impairment, comorbidities, or low functional levels had lower guideline adherence. This large patient subgroup needs a higher treatment focus and more resources. Our findings are likely similar to those in other national and international institutions. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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