The 30 days mortality rate was also significantly decreased and was kept at a low level compared with international standard [4, 6]. Our mortality rate was 1.67% in 2009. The rate in

2007 and 2008 are 1.7%. The 28 days re-admission rate after discharge from hospital remains static at 15%. Among these patients, about 64% are medical problems related. In 2006, the infection rates of the internal fixation and hemiarthroplasty Smad inhibitor were 0.81% and 2.61%, respectively. This infection rate was reduced and kept low since 2007. The infection rate of internal fixation was kept at 0% in 2008 and 2009. The infection rate of hemiarthroplasty was also reduced to 0.98% in 2009 (Fig. 4). Fig. 4 Surgical site infection rate Regarding the social aspect of these hip fracture patients, the difficulties lie in the multiple factors that cause delay in discharge and rehabilitation. Medical social workers are very helpful in this aspect. Since the start of the clinical pathway, over 99% of the hip fracture patients were assessed and helped by medical social workers. Together with the effort from nurses and therapist, we are able to discharge 81% of the patients back to their premorbid living environment CP-868596 order (Fig. 5). Besides, a lot of post

discharge help care providers are involved in the initial re-integration of the patients back to the society, for example, day care centres, geriatric day hospitals, maid care, non-government organisations or combination of the above. Fig. 5 Placement after discharge from hospital Discussion Our hospital is one of the first to adopt a multidisciplinary approach to manage the geriatric hip fracture patients from acute hospital to convalescence hospital in Hong Kong and probably in Asia as well. The patients are taken care of by different professions using a systematic approach from the minute when they are admitted through the accident and emergency department till they walk out the door of the rehabilitation hospital. In 2009, there were more than 4,400

hip fractures operated in Hong Kong. In average, 68% of the Pomalidomide mw patients were operated within 2 days after admission. In our hospital, we have 86% of our patients operated within 2 days after admission. This is, to our understanding, one of the best performances in our locality. Moreover, the hip fractures are only operated in day time. Furthermore, this pre-operative shortened length of stay also indirectly relates to a similar shortening of total length of stay in acute hospital. Although there is still a lot of debate on the timing of surgery relating to mortality, hip fracture outcome or complications, we are confident that shortening the pre-operative stay by better communication between surgeons, anaesthetists and physicians, more efficient use of resources and better monitoring of the system will, by simple logic, improve the outcomes and decrease the suffering of our patients. According to our data, there is a general trend of increasing age in our hip fracture patients.