The ageing of our population and rise in chronic diseases has resulted in the complex profile of the patients in the community. Complex wounds such as diabetic foot ulcers, infected pressure ulcers and other complications of non-healing wounds are common encounters in the primary health settings. The challenges of these complex wounds lie in its multi-factorial nature of the person, the wound and the environment. This requires a team approach to care within the limited resources boundary. As part of the care continuum, it is essential for primary care physicians to be familiarized with the approach to care of complex wounds and the adjunct therapy. This article seeks to provide a broad framework using the systematic assessment framework via T.I.M.E (Tissue, Inflammation/Infection, Moisture imbalance, Epithelial edge of wound) for wound bed preparation to guide primary care physicians/clinicians in their approach to complex wounds. It also highlighted the complexities of chronic wound management pertaining to the person, the wound and the environment as well as the recent advances adjunct therapy in chronic wound care. In addition, it seeks to enable primary care physician and wound clinicians to translate wound-healing principles into effective management strategies to provide better clinical care to our patients.

INTRODUCTIONThe effectiveness of integrated care pathways for hip fractures in subacute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a subacute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations.

MATERIALS AND METHODSA randomised controlled trial on an integrated care pathway for hip fracture patients in a subacute rehabilitation setting. Modified Barthel Index, ambulatory status, SF-12, length of stay, discharge destination, hospital readmission and mortality were measured. Followup assessments were up to 1 year post-hip fracture.

RESULTSThere were no significant differences in Montebello Rehabilitation Factor Scores and proportions achieving premorbid ambulatory status at discharge, 6 months and 12 months respectively. There was a significant reduction in the median length of stay between the control group at 48.0 days and the intervention group at 35.0 days (P = 0.009). The proportion of readmissions to acute hospitals was similar in both groups up to 1 year. There were no significant differences for nursing home stay up to 1 year post-discharge and mortality at 1 year.

CONCLUSIONOur study supports the use of integrated care pathways in subacute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.

Hip Fractures ; Humans ; Prospective Studies