Care for People With Fragility Fractures
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 a summary of the quality standard or download it for more detailed statements.
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Quality Statement 1: Emergency Department Management
People with suspected hip fracture are diagnosed within 1 hour of arriving at hospital. Preparation for surgery is initiated, and they 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
People with hip fracture receive surgery as soon as possible, within 48 hours of their first arrival at any hospital (including any time spent in a nonsurgical hospital).
Quality Statement 3: Multimodal Analgesia
People with suspected hip fracture have their pain assessed within 30 minutes of arriving at hospital and managed using a multimodal approach, including consideration of nonopioid systemic analgesics and peripheral nerve blocks.
Quality Statement 4: Surgery for Stable Intertrochanteric Fractures
People diagnosed with a stable intertrochanteric fracture are treated surgically with a sliding hip screw or cephalomedullary nail.
Quality Statement 5: Surgery for Subtrochanteric or Unstable Intertrochanteric Fractures
People diagnosed with a subtrochanteric fracture or unstable intertrochanteric fracture are treated surgically with an intramedullary nail.
Quality Statement 6: Surgery for Displaced Intracapsular Fractures
People diagnosed with a displaced intracapsular fracture are treated surgically with arthroplasty.
Quality Statement 7: Postoperative Blood Transfusions
People 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
People with hip fracture are mobilized to weight-bearing as tolerated within 24 hours following surgery.
Quality Statement 9: Daily Mobilization
After surgery, people with hip fracture are mobilized on a daily basis to increase their functional tolerance.
Quality Statement 10: Screening for and Managing Delirium
People with hip fracture are screened for delirium using a standardized, 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. They receive interventions to prevent delirium and to promote recovery if delirium is present.
Quality Statement 11: Postoperative Management
People with hip fracture receive postoperative care from an interprofessional team in accordance with principles of geriatric care.
Quality Statement 12: Information for Patients, Families, and Care Partners
People with hip fracture and their families and care partners are given information on patient care that is tailored to meet their needs and delivered at appropriate times in the care continuum.
Quality Statement 13: Rehabilitation
People with hip fracture participate in an interprofessional rehabilitation program (in an inpatient setting, a community setting, or a combination of both) with the goal of returning to their prefracture functional status.
Quality Statement 14: Osteoporosis Management
While in hospital, people with hip fracture undergo a fracture risk assessment from a clinician with osteoporosis expertise and, when appropriate, are offered medications for osteoporosis.
Quality Statement 15: Follow-Up Care
People with hip fracture are discharged from inpatient care with a scheduled follow-up appointment with a primary care provider within 2 weeks of discharge and a scheduled follow-up appointment with the orthopaedic service within 12 weeks of their surgery.