Abstract
Our hospital is the principal hospital in the Masuda area of Shimane Prefecture, but as it is also an emergency hospital, the admission period in each patient is restricted to within 17 days. The number of long-stay beds in nearby hospitals is also limited. Under such circumstances, we have been trying to shorten the admission period.
[Subjects and Methods] The subjects were 243 patients (51 males, 192 females; mean age, 80.0 years) with fractures in the femoral neck and trochanter region, who underwent treatment in our hospital between January 1, 1997 and December 31, 2002. Our plan consisted of the setting of the date of discharge at an early stage of admission for each patient, confirmation of the intention of the family to care for the patient, arrangement of a transfer of the patient to another hospital, if it was wished, in cooperation with MSW, early start of load-bearing, and introduction of the clinical path.
[Results] The period of admission decreased significantly from 72.0 days before the introduction of the clinical path to 43.5 days after its introduction. The outcome as evaluated by the poor-outcome/good-outcome ratio did not change significantly (from 13/193 to 2/48). The functional outcome as evaluated by walking ability had worsened from 77/116 to 23/27. This was particularly evident with patients with fractures in the trochanter region,in which the functional outcome ratio was 51/68 and 15/13 before and after the introduction, respectively.
[Discussion and Conclusions] Focus on early discharge of patients, shortened the rehabilitation period was shortened, resulting in worsening of the functional outcome at the time of discharge.
