Usefulness of Electric Clinical Pathway for Prevention of Thrombosis Events in Hip Fracture by Standardization of Treatment

Abstract

The purpose of this study was to investigate the usefulness of electric clinical pathway (ECP), which supports the standardization of medical processes, to prevent thrombotic events in hip fracture patients. Our ECP for hip fracture, which includes the seventh-day postoperative measurement of the serum D-dimer level and antithrombotic drug therapy for two weeks postoperatively, was started to use in March 2009. This study includes 53 patients continuously using ECP (ECP group), and 53 patients not using ECP (control group) who were treated before February 2009. The rates of D-dimer level check and antithrombotic drug administration were analyzed. In addition, the D-dimer levels of both groups were compared. Computed tomography of the lungs and lower extremities was performed on in cases with D-dimer level> 20 microgram per ml, in order to confirm whether they had thrombosis events such as pulmonary embolism (PE) or deep venous thrombosis (DVT). In the ECP group, the D-dimer level was found to be 96.2% and the rate of use of antithrombotic drugs was 81.1%. In contrast, these percentages were 88.7% and 26.4% in the control group. Five cases showed PE in the control group and none in the ECP group. These results suggest that ECP promotes medical standardization and improves the quality of treatment.