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Evidence to Improve Care

Hip Fracture

Care for People With Fragility Fractures

Click below to see a list of brief quality statements and scroll down for more information.


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.


Quality Statement 1: Emergency Department Management
Patients with suspected hip fracture are diagnosed within 1 hour of arriving at hospital. Preparation for surgery is initiated, and patients are admitted and transferred to a bed in an inpatient ward within 8 hours of arriving at hospital.


Quality Statement 2: Surgery Within 48 Hours
Patients with hip fracture receive surgery as soon as possible, within 48 hours of their first arrival at any hospital (including any time spent in anonsurgical hospital).


Quality Statement 3: Multimodal Analgesia
Patients with suspected hip fracture have their pain assessed within 30 minutes of arriving at hospital and managed using a multimodal approach, including consideration of non-opioid systemic analgesics and peripheral nerve blocks.


Quality Statement 4: Surgery for Stable Intertrochanteric Fractures
Patients diagnosed with a stable intertrochanteric fracture are treated surgically with sliding hip screws.


Quality Statement 5: Surgery for Subtrochanteric or Unstable Intertrochanteric Fractures
Patients diagnosed with a subtrochanteric fracture or unstable intertrochanteric fracture are treated surgically with intramedullary nails.


Quality Statement 6: Surgery for Displaced Intracapsular Fractures
Patients diagnosed with a displaced intracapsular hip fracture are treated surgically with arthroplasty.


Quality Statement 7: Postoperative Blood Transfusions
Patients with hip fracture do not receive blood transfusions if they are asymptomatic and have a postoperative hemoglobin level equal to or higher than 80 g/L.


Quality Statement 8: Weight-Bearing as Tolerated
Patients with hip fracture are mobilized to weight-bearing as tolerated within 24 hours following surgery.


Quality Statement 9: Daily Mobilization
After surgery, patients with hip fracture are mobilized on a daily basis to increase their functional tolerance.


Quality Statement 10: Screening for and Managing Delirium
Patients with hip fracture are screened for delirium using a validated tool as part of their initial assessment and then at least once every 12 hours while in hospital, after transitions between settings, and after any change in medical status. Patients receive interventions to prevent delirium and to promote recovery if delirium is present.


Quality Statement 11: Postoperative Management
Patients with hip fracture receive postoperative care from an interdisciplinary team in accordance with principles of geriatric care.


Quality Statement 12: Patient, Family, and Caregiver Information
Patients with hip fracture and/or their family and caregivers are given information on patient care that is tailored to meet the patient’s needs and delivered at appropriate times in the care continuum.


Quality Statement 13: Rehabilitation
Patients with hip fracture participate in an interdisciplinary rehabilitation program (in an inpatient setting, a community setting, or a combination of both) with the goal of returning to their pre-fracture functional status.


Quality Statement 14: Osteoporosis Management
While in hospital, patients with hip fracture undergo an osteoporosis assessment from a clinician with osteoporosis expertise and, when appropriate, are offered pharmacologic therapy for osteoporosis.


Quality Statement 15: Follow-Up Care
Patients with hip fracture are discharged from inpatient care with a scheduled follow-up appointment with a primary care provider within 2 weeks of returning home and a scheduled follow-up appointment with the orthopaedic service within 12 weeks of their surgery.

1

Emergency Department Management

Patients with suspected hip fracture are diagnosed within 1 hour of arriving at hospital. Preparation for surgery is initiated, and patients are admitted and transferred to a bed in an inpatient ward within 8 hours of arriving at hospital.


To reduce delays to surgery, patients with suspected hip fracture should be rapidly assessed, diagnosed, and prepared for surgery upon arrival at hospital. Once a hip fracture is diagnosed, patients should receive a preoperative assessment, including admission and transfer to an inpatient bed within 8 hours. If a patient is to be transferred to another hospital for surgery, preparations for their transfer should begin after diagnosis.

For Patients

You should be seen by a doctor within 1 hour of arriving at the hospital so you can be diagnosed and receive treatment as quickly as possible. You should be transferred to an inpatient bed within 8 hours of arriving at the hospital.


For Clinicians

If you suspect that a person has a hip fracture, ensure that they are diagnosed, that preparation for surgery is initiated, and that the patient is transferred to an inpatient bed within 8 hours.


For Health Services

Ensure that systems, processes, and resources are in place to assist clinicians with the assessment of people with suspected hip fracture. This includes ensuring access to validated assessment tools, laboratory testing, necessary imaging, and areas for physical examination; providing the time required for a full assessment; and ensuring availability of trained professionals.

Process Indicator

Percentage of patients with a suspected hip fracture who have imaging (typically x-ray) and who are seen by a physician within 1 hour of arrival at hospital

  • Denominator: total number of adults presenting to hospital with suspected hip fracture

  • Numerator: number of people in the denominator who have imaging (x-ray, CT scan, or MRI) and are seen by a physician within 1 hour of arrival at hospital

  • Data source: local data collection

Percentage of patients with a confirmed hip fracture who are transferred to an inpatient bed within 8 hours of arrival at hospital

  • Denominator: total number of adults presenting to hospital with a primary diagnosis of fragility hip fracture

  • Numerator: number of people in the denominator who are transferred to an inpatient bed within 8 hours of arrival at hospital

  • Data source: local data collection

Percentage of hip fracture patients who receive initial preparation for surgery within 8 hours of arrival at hospital

  • Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture

  • Numerator: number of people in the denominator who receive bloodwork, consultations (e.g., orthopaedic surgery, anaesthesia), ECG, and medication adjustment or discontinuation as needed within 8 hours of arrival at hospital

  • Data source: local data collection


Structural Indicator

Percentage of surgical hospitals that have a protocol, including a standardized order set, to prioritize the admission process for hip fracture patients such that they are admitted and transferred to an inpatient bed within 8 hours

  • Data source: Regional and/or provincial data collection method would need to be developed

Hip fracture diagnosis

Hip fracture diagnosis requires a clinical assessment by a physician, imaging (typically x-ray; rarely computerized tomography [CT] or magnetic resonance imaging [MRI]), and subsequent imaging interpretation to confirm the diagnosis.


Initial preparation for surgery

Further assessments may be needed once the patient is transferred out of the emergency department. Initial preparation for surgery involves the following, which should occur within 8 hours of arrival at hospital:

  • Baseline information and history, including pre-fracture functional status, cognitive status, and delirium screen

  • Bloodwork

  • Consultations as needed

  • Electrocardiography (ECG)

  • Medication adjustment or discontinuation as needed

  • Preparation for transfer if patient is to be transferred to another hospital for surgery

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