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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.

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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.


Patients value receiving explanations about their condition and information about their anticipated path to recovery. Early discussion of prognosis, expectations, rehabilitation, and the care pathway may avoid discharge delays, reduce length of hospital stay, and prevent unnecessary readmission to hospital. Patients (and, as appropriate, their family or caregivers) should be provided with timely information throughout the care continuum verbally and in a printed or multimedia format.

For Patients

Throughout your care journey, you and your caregivers should be given information about your care. This information should be offered to you in a variety of ways, including verbally, written down, or in a video.


For Clinicians

Provide your patients with information that is tailored to meet their learning needs in a format and at times that are most appropriate for them.


For Health Services

Ensure that appropriate educational resources are available for clinicians to use with their hip fracture patients. These resources should be available in written and multimedia formats.

Structural Indicator

Percentage of hospitals that have educational resources available for hip fracture patients related to their care (see list provided in Definitions)

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

Information on patient care

At a minimum, information on patient care for hip fracture patients and their family and/or caregivers should address the following:

  • Diagnosis

  • Elements of the care plan

  • Types of anaesthesia

  • Medications

  • Health care professionals involved

  • Types of surgery

  • Possible complications of surgery

  • Postoperative care

  • Delirium prevention and management

  • Discharge plan

  • Rehabilitation programs

  • Potential long-term outcomes

  • Assistive devices that may be needed following surgery

  • Nutrition

  • Osteoporosis management

  • Effect of surgery on activities and travel

  • Fall prevention

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Claude Lurette and Kowsiya Vijayartnam, Health Quality Ontario Patient, Family and Caregiver Advisors Council Co-Chairs

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