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Enhanced Geriatric Fractured Hip Clinical Pathway to Reduce Post-Operative Delirium

Cherry WANG, Aaron LEE, Yu-Fai CHUNG, Timmy CHAN, David LAM
Queen Mary Hospital, Hong Kong West Cluster, Hong Kong

Background: Delirium in elderly orthopaedic patients pose an enormous medical, social and financial burden to Hong Kong’s healthcare system, as well as significant distress to patients and their caregivers. We examined whether a multi-component cubicle environment could reduce the incidence of post-operative delirium in fractured hip patients.

Methods: An observational study was conducted, analysing 154 patients (mean age ± SD, 85 ± 7.8, 68% women) admitted to Queen Mary Hospital with hip fractures. Half of the patients were cared for under the conventional existing general orthopaedic ward before a specialised geriatric cubicle was introduced. Interventions included orientation aids, increasing access to caregivers and an enhanced analgesia protocol with regional techniques pre-operatively and intra-operatively. A multi-disciplinary team were available to detect and support the patient’s functional needs. Delirium was diagnosed using the short CAM algorithm.

Results: There were fewer patients with post-operative delirium in the interventional cubicle group, compared with the general ward (18/76, 23.4% v 34/76, 44.2%, p = 0.006).  Cubicle group patients experienced less dizziness post-operatively than the general group (2/77, 2.6% v 13/77, 16.9%, p = 0.003). The median day the cubicle group started walking post-operatively was on day one, whilst the general ward group started walking on day two (p=0.001). Less systemic opioids were given to the cubicle group. Length of stay was not affected.

Conclusion: Multiple components tackling delirium were successfully implemented. Opioid sparing techniques contributed to better outcomes. A dedicated cubicle for vulnerable patients has been shown to reduce the incidence and prevalence of delirium.

Table 1. Delirium detected. Values in total (%)

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