Page 116 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F1.3 Better Manage Growing Demands 10:45 Room 421

Effectiveness of Multidisciplinary Clinical Pathway for Geriatric Patients with Acute Osteoporotic Vertebral
Compression Fractures
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Cheung WY , Chiu PKC , Woo YC , Koon NF , Tsang PLC , Faan Y , Tsang P , Ng YL , Kwok TWW , Chan A , Kwong T ,
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Fan TY , Kong LL 11
1 Department of Orthopaedics and Traumatology, Department of Medcine, Department of Physiotherapy, Queen Mary Hospital,
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4 Department of Physiotherapy, MacLehose Medical Rehabilitation Centre, Department of Physiotherapy, TWGHs Fung Yiu
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King Hospital, Department of Occupational Therapy, MacLehose Medical Rehabilitation Centre, Department of Occupational
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Therapy, TWGHs Fung Yiu King Hospital, Department of Prosthetics and Orthotics, Queen Mary Hospital, Department
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of Prosthetics and Orthotics, MacLehose Medical Rehabilitation Centre, Department of Dietitian, Queen Mary Hospital,
11 Department of Qaulity and Safty, Queen Mary Hospital, Hong Kong
Introduction
Osteoporotic vertebral compression fracture is a common clinical condition requiring hospital admission. It does not only
impact on the physical and psychological health of patients, but also on the demand for hospital services. Multidisciplinary
treatment, including doctors, dietitians, nurses, occupational therapists, physiotherapists, prosthetist-orthotists and medical
social workers is frequently required. To improve the management of elderly patients with acute osteoporotic vertebral
fracture admitted to our department, a multidisciplinary clinical pathway was introduced in January 2016.
Monday, 7 May 2018 A prospective cohort study was carried out to assess the effectiveness of this clinical pathway. Patients treated in the
Objectives
pathway were compared to those treated before the implementation of the pathway.
Methodology
A multidisciplinary clinical pathway was designed and implemented for management of patients aged more than 65 years
admitted to our department for acute osteoporotic vertebral compression fractures. Patients recruited to the pathway from
1 January 2017 to 30 September 2017 were included in the study. Data including numeric pain score, elderly mobility score,
modified Barthel Index on admission and upon hospital discharge, duration of acute and rehabilitation hospital stay were
prospectively collected.
A retrospective review of patients admitted to our hospital before implementation of the clinical pathway from 1 November
2013 to 30 June 2014 was carried out to assess their length of stay in acute and rehabilitation hospital and the results were
compared with those treated with the clinical pathway.
Results
113 patients were recruited to the clinical pathway cohort with a mean age of 82 years. 90 patients (80%) were female.
Numeric pain score and elderly mobility score improved from 7 to 4 and 6 to 12 respectively after treatment. The Modified
Barthel Index which reflected activities of daily living of slightly dependent or independent group increased from 7% to 23%
after treatment. The differences were all statistically significant. The average length of stay in acute and rehabilitation hospital
was 5 days and 8 days respectively.
160 patients treated before implementation of the clinical pathway were recruited to the retrospective review with an average
age of 83 years. The average length of stay in acute and rehabilitation hospital was 7 day and 11 days respectively. The
difference in acute hospital stay before and after implementation of the pathway was statistically significant.
Conclusion
A multidisciplinary treatment pathway for geriatric osteoporotic vertebral fractures can significantly improve patients’ clinical
outcomes and shorten the acute hospital length of stay.

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