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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.

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.


A follow-up appointment with a primary care provider within 2 weeks of returning home can help ensure that patients are recovering well from their hip fracture and that any other medical conditions (including osteoporosis) are being managed so that patients can successfully returnto their pre-fracture status. In addition to a primary care follow-up, an appointment with the orthopaedic service should be scheduled within 12 weeks of surgery to allow for an assessment of the outcome of surgery and to facilitate a successful recovery.

For Patients

You should have an appointment with a primary care provider within 2 weeks of returning home, plus a follow-up appointment with the hospital’s orthopaedic service within 12 weeks of your surgery.


For Clinicians

Contact your patient’s primary care provider before the patient is discharged from hospital to schedule an appointment within 2 weeks to coordinate transfer of accountability. At discharge, a summary of the patient’s hospital stay should be sent to the primary care provider.


For Health Services

Ensure that systems, processes, and resources are in place to allow all postoperative hip fracture patients to access a follow-up appointment with a primary care provider within 2 weeks of discharge and to access a follow-up appointment with the orthopaedic service within 12 weeks of surgery.

Process Indicators

Percentage of hip fracture patients whose primary care provider is contacted before returning home (including primary care providers for long-term care homes) to schedule a follow-up appointment

  • 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 whose primary care provider is contacted before returning home to schedule a follow-up appointment

  • Data source: local data collection


Percentage of hip fracture patients whose primary care provider (including primary care providers for long-term care homes) receives a discharge summary prior to or at the primary care follow-up appointment

  • 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 whose primary care providers receive a discharge summary prior to or at the patient’s primary care follow-up appointment

  • Data source: local data collection


Percentage of hip fracture patients who are seen by a primary care provider within 2 weeks of returning home

  • 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 are seen by a primary care provider within 2 weeks of returning home

  • Data source: Discharge Abstract Database, Ontario Health Insurance Program (OHIP) claims database


Percentage of hip fracture patients who are seen by the orthopaedic service within 12 weeks of discharge from hospital

  • 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 are seen by the orthopaedic service within 12 weeks of discharge from hospital

  • Data source: Discharge Abstract Database, local data collection, Ontario Health Insurance Program (OHIP) claims database

Orthopaedic service

A hospital’s orthopaedic service consists of a team of health care professionals involved in orthopaedic care; for example, orthopaedic surgeons, nurse practitioners, and physical therapists. At their follow-up appointment with the hospital’s orthopaedic service, hip fracture patients may be seen by any member of the orthopaedic service.

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