Scottish Intercollegiate Guidelines Network (SIGN) (2009) Management of hip fracture in older people. A national clinical guideline. SIGN, Edinburgh, June 2009 11. British Orthopaedic

Association Standards for Trauma (BOAST) (2007) Hip fracture in the older person. British Orthopaedic Association, September 2008 12. Leonard KL (2008) Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect. J Health Econ 27(2):444–459CrossRefPubMed”
“Introduction Geriatric hip fracture is a worldwide problem. It imposes a great burden on the resources used in health-care system nowadays [1–3]. The problem is ever increasing in Hong Kong as well. The total number of hip fractures operated in government hospital rises from around 4,000 patients in 2006 to around 4,500 patients in 2009. The mortality rate of these patients is also significant. The 1 year mortality Smoothened inhibitor can be up to 33% [4]. Post-operative complications like chest infection and heart failure are also shown to increase Regorafenib mouse mortality rate [4]. In view of these, many centres would like to improve their clinical outcomes, and at the same time, to reduce the costs. It was shown to

be effective by a multidisciplinary approach or the use of critical clinical pathway [5, 6]. Background In year 2006, the need of reforming the hip fracture management becomes one of the primary objectives in our department in view of the increasing number of hip fractures and the lack of systematic approach to this problem. Various clinical pathways from other parts of the world were reviewed. There were good and bad points about individual pathway. Nevertheless, the most important consideration is that

the clinical pathway should be suitable to the uniqueness and culture of the Hong Kong medical system. In late 2006, we decided to call for a meeting to gather all the appropriate professions to start the first review of our geriatric hip fracture management. Besides the medical profession, the hospital administration provided full support to the development of this clinical pathway. Problems identification The aim of our clinical pathway is to standardise the management of geriatric hip fracture so that these patients can be taken care pentoxifylline of effectively and promptly when they are managed by the frontline staff. The goal is to improve patients’ clinical outcomes with good quality of care. It should also bring reduction of the cost of care. It should be stressed that the pathway should not be considered as the selleck inhibitor golden rule. Individual clinical assessment and management should be respected as different patients have different needs. However, the pathway can help us facilitate our thinking and thus our clinical management. One of the most tedious but important thing before the pathway started was to identify the problems and determine the solutions. During this process, some historical data were collected before we could proceed.