Succesful Swedish Solution for Patients with Hip Fractures

6 Feb 2013

A Succesful Swedish Care Solution for Patients with Hip Fractures

Every year there are closer to 18,000 hip fractures in Sweden. The estimated cost of care is approximately 2,3 billion SEK. A few years ago the University Hospital in Lund implemented the so called Hip Line, an optimized clinical pathway for patients with hip fractures. Behind the initiative stood nurse Ami Hommel, who claimed that a more efficient, preoperative care would result in reduced postoperative care and risk for complications in patients. Today around 30 Swedish hospitals have embraced her ideas. The Hip Line is a great example of successful care solutions from Sweden.

Swedish Health Care asked Ami Hommel to describe the Hip Line, the ideas behind it and how it works.

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Ami Homel

– The Hip Line is a fast track for older patients with a suspected hip fracture, which implicates a deliberate treatment, from a higher priority ranking at the emergency service center, a registered nurse present in the ambulance, via operation and hospital care, to rehabilitation and after-care. The ambulance nurse provides the patient with oxygen, fluids and analgesic, takes an ECG and blood samples and prepares for the reception at the hospital. On arrival at the hospital the patient is immediately transported to x-ray and from there to a hospital ward.

What needs formed the basis of your idea?

The Hip Line has developed from the care chain implemented in Lund in 2004, which meant that we cut out the process of bringing the patients back down to the emergency department after their x-ray. When I doctored in 2007 and managed to show how much better the results were after the implementation of the care chain, the head of the emergency department, Kjell Ivarsson, contacted me and was of the opinion that my ideas could be developed further.

How does the Hip Line affect the patients?

– In general, they feel safer since the number of persons they meet has been reduced. The ambulance nurse accompanies them until they have arrived at the hospital ward, which means less risk of confusion and the possibility of shorter waiting time before surgery. Earnings are shorter hospital stay and faster recovery.

What does the Hip Line mean in terms of availability, economy and quality of care?

– It means that this relatively large group of patients does not occupy places at the emergency department, which in turn means that other patients can get help faster. For the staff in x-ray it means that they get help moving the patient to and from the x-ray table, and they also meet a patient who is not in as much pain and therefore feels much safer. The staff at the ward experience that the patients feel better and are not as confused as they used to be.

Can the system be developed even further?

The main objective is to mobilize the patients ever sooner than today. When it comes to application of the system to other patient groups, you just have to use your imagination. Within the elective care, much work is done with fast tracks and this can most definitely be developed even further within the emergency care. Patients not having to go through the emergency department have no reason to be there.


Name: Ami Hommel

Title: Registered nurse, associate professor and clinical lecturer. Coordinator of the national record of quality, ”Rikshöft”.

Career: Started cleaning at the University Hospital in Lund in 1976. Worked as an assistant nurse up until 1981 when she became a registered nurse. She worked at the orthopeadic clinic as a nurse until 1998 when she began her work in research. Doctored in 2007 and became an associate professor in 2012. Since 2005 she has also been employed at the University of Lund and as a clinical lecturer at the orthopedic clinic.

In 2009 Ami Hommel was awarded the newly established care-prize of Salus Ansvar for her research. Today she is an expert at SKL, the national organisation for Swedish local authorities and regions, in the area of pressure ulcers and quality records.

She is a boardmember of Wound Healing Nurses in Sweden and Othopeadic Nurses in Sweden.

She works internationally in Fragility Fracture network and is the chairman of the International Collaboration Orthopeadic Nursing.

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