CRITICAL PATH-ANALYSIS FOR THE MANAGEMENT OF FRACTURED NECK OF FEMUR

The aim of this study was to determine the effect of a critical path a nalysis, used as a management tool, on the efficiency of clinical serv ice delivery for patients with a fractured neck of femur. It is a befo re-and-after study of the medical records of all patients admitted bet ween October 1992 and October 1993 with a primary diagnosis of fractur ed neck of femur, but excluding patients under 50 years old and those with multiple fractures or metastatic disease. Patients fell into two groups: those admitted in the six months before the introduction of a clinical management program based on a critical path analysis, and tho se admitted after the introduction of the program in April 1993 (88 pr ogram cases and 90 nonprogram cases). A medical records administrator blinded to the program category of the patients independently coded di agnostic data, while other data were abstracted from the clinical note s. The length of stay for a fractured neck of femur declined from a me an of 19.3 days to a mean of 11.0 days (P < 0.0001). The outcome measu res were: the distance walked just before discharge from hospital, the discharge destination, and unplanned readmission. These did not chang e significantly, and the wound infection rate declined during the peri od of the intervention. The implementation of a clinical management pa thway based on a critical path analysis dramatically reduced the lengt h of stay for patients admitted with a fractured neck of femur while m aintaining quality of outcomes. Critical path analysis is a useful man agement tool to improve the efficiency of certain clinical services.