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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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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.


On discharge from the acute care hospital, all hip fracture patients—including patients with cognitive impairment and those residing in long-term care homes—should have the opportunity to participate in an active interdisciplinary rehabilitation program. Rehabilitation programs have been shown to improve patient outcomes, including but not limited to functional status, leg strength, health status, balance, mobility, instrumental activities of daily living, and social functioning.

For Patients

When you leave the hospital, you should be offered a rehabilitation program to help get you back to the activities you were able to do before your fracture.


For Clinicians

Provide a rehabilitation program to your hip fracture patients that includes therapies to improve independence in self-care, balance and gait assessment and training, nutritional supplementation, education on safety and fall prevention, a restorative and/or maintenance exercise program, environmental modifications, osteoporosis management and education, and medication management.


For Health Services

Ensure that systems, processes, and resources are in place to allow all hip fracture patients, regardless of cognitive impairment or setting, to participate in a rehabilitation program following surgery.

Process Indicators

Percentage of hip fracture patients who participate in a postoperative interdisciplinary rehabilitation program

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

  • Numerator: number of people in the denominator who participate in a postoperative interdisciplinary rehabilitation program

  • Data source: Continuing Care Reporting System, Discharge Abstract Database, Home Care Database, National Rehabilitation Reporting System, local data collection

Median number of days after surgery that hip fracture patients begin a rehabilitation program

  • Data source: Continuing Care Reporting System, Discharge Abstract Database, Home Care Database, National Rehabilitation Reporting System, local data collection

Rehabilitation program

An effective hip fracture rehabilitation program includes the following:

  • Therapies to improve independence in self-care

  • Balance, strengthening, and gait assessment and training

  • Nutritional supplementation

  • Education on safety and fall prevention

  • Environmental modifications

  • Osteoporosis management and education

  • Medication management

  • Pain management education

  • Positioning education for comfort and pressure relief

  • Transfer training

  • Stair training

  • An ongoing exercise program following completion of formal rehabilitation

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