[Hip Fractures in Adults - Contemporary Clinical Management Based on International Standards].

BACKGROUND

Patients with hip fractures, often of advanced age and with multimorbidity-trauma, require early surgery and interdisciplinary treatment in order to avoid complications and reduce morbidity and mortality. "Time to surgery" is a sensitive quality indicator (QI) for the treatment process, reflecting multiple factors. Due to persistently noticeable problems in relation to this QI in external inpatient quality assurance in Germany, a special need for action was identified by the Federal Joint Committee (Gemeinsamer Bundesausschuss - G-BA).

OBJECTIVES

Identification of methodologically particular reliable recommendations to establish structural and procedural standards to ensure adequate clinical care.

METHODS

Systematic international web-based research and analysis of relevant guidelines for domain 3 of the AGREE II instrument; extraction of distinct, methodologically well-founded recommendations; supplementing the guideline analysis with an assessment of regulations with structure and process requirements or criteria for quality and care standards.

RESULTS

Out of 66 identified, context-relevant guidelines, 15 were of "high methodological quality". Out of these 15, particular reliable recommendations could be extracted-among others - regarding surgical technique, combined orthogeriatric treatment, antibiotics, pressure ulcers and thromboembolic prophylaxis, time to surgery, anesthetics, physiotherapy, postoperative management and delirium. Further structural and procedural specifications could be extracted from nine other sets of rules.

CONCLUSIONS

Surgery as early as possible and adequate care can be assured through a consistent, multifactorial, interdisciplinary and coordinated team approach in well structured and adequately staffed facilities of appropriate quality.