Hip Fracture - Quality Statement 11: Postoperative Management

Resources Quality Statements Advisory Committee About

Postoperative Management

Patients with hip fracture receive postoperative care from an interdisciplinary team in accordance with principles of geriatric care.

Background

Care for hip fracture patients should be guided by an orthopaedic surgeon in collaboration with a clinician familiar with geriatric principles. For example, an orthopaedic surgeon may partner with a geriatrician, clinical nurse specialist, nurse practitioner, hospitalist, or internal medicine practitioner to coordinate care for a hip fracture patient. This care partnership ensures that geriatric considerations regarding surgical and medical decisions are addressed from the time of admission throughout the continuum of care.

What This Quality Statement Means

For Patients

You should receive care from a team of health care professionals who understand the health needs of older adults.

For Clinicians

Following hip fracture surgery, ensure your patient continues to receive care from a surgical–medical partnership that takes into consideration the unique needs of geriatric patients. While the patient is still in hospital recovering from surgery, encourage appropriate nutritional intake and hydration, closely monitor and address the patient’s risk of developing pressure injuries, and ensure proper venous thromboembolism prophylaxis.

For Health Services

Ensure that appropriate human resources are in place such that a medical–surgical partnership is possible for the care of hip fracture patients. Additional resources may include protocols, hip fracture pathways, medical directives, and standardized order sets to facilitate the implementation of principles of geriatric care.

Quality Indicators

Process Indicators

Percentage of hip fracture patients who are managed by both an orthopaedic surgeon and a clinician with geriatric expertise

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 an orthopaedic surgeon and a clinician with geriatric expertise
Data source: local data collection

Percentage of hip fracture patients who receive venous thromboembolism prophylaxis while in 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 receive venous thromboembolism prophylaxis while in hospital
Data source: local data collection

Percentage of hip fracture patients who receive an indwelling catheter postoperatively

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 receive an indwelling catheter postoperatively
Data source: local data collection

Structural Indicator

Percentage of hospitals with access to a clinician with geriatric expertise

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

Definitions Used Within This Quality Statement

Postoperative care from an interdisciplinary team

Management for hip fracture patients should include, at a minimum, the following clinical interventions and senior-friendly considerations:

Nutritional intake should be assessed and protein and high-energy supplements provided if required
Risk assessment for pressure injuries should be performed using the Braden Scale or another validated instrument. Precautions should be taken, including proper turning and repositioning, to prevent the development of pressure injuries
If postoperative catheterization is necessary, an intermittent catheter should be used rather than an indwelling catheter
Appropriate hydration should be provided to help prevent delirium while carefully balancing the risk of fluid overload; for example, with intravascular or oral fluids
Venous thromboembolisms should be prevented using medical rather than mechanical strategies (unless medications are contraindicated)
A fall risk assessment should be performed
A comprehensive medication review and reconciliation should be performed

Evidence to Improve Care