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 Statements in Brief

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.

Resources Quality Statements Advisory Committee About

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.

Background

As people age, the incidence of fragility fractures increases, owing to the higher incidence of osteoporosis in older populations. Treatment for osteoporosis leads to a reduction in re-fractures and mortality and a decreased rate of new fractures. All patients with fragility hip fractures are at high risk for future fractures, and pharmacologic intervention should be offered to all patients while in hospital, subject to contraindications. Bone mineral density testing to monitor treatment efficacy should be considered in those who accept osteoporosis treatment.

What This Quality Statement Means

For Patients

While you are in the hospital, a health care professional should assess you for osteoporosis (which causes bones to become brittle) and offer you the appropriate medication to help your bones be as healthy as possible.

For Clinicians

While your patient is still in hospital recovering from surgery, perform an osteoporosis assessment, and offer an osteoporosis medication (e.g., a bisphosphonate or bisphosphonate derivative, monoclonal antibody, or parathyroid hormone analog) unless they are already on osteoporosis medication or such medications are contraindicated.

For Health Services

Ensure that systems, processes, and resources are in place to allow all postoperative hip fracture patients to access a clinician with osteoporosis expertise who is qualified to perform osteoporosis assessments and prescribe osteoporosis medications.

Quality Indicators

Process Indicators

Percentage of hip fracture patients who receive an osteoporosis assessment from a clinician with osteoporosis 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 receive an osteoporosis assessment from a clinician with osteoporosis expertise
Data source: local data collection

Note: Patients with a fragility hip fracture who are already on osteoporosis medications or for whom osteoporosis medications are contraindicated are excluded.

Percentage of hip fracture patients who are diagnosed with osteoporosis and started on an osteoporosis medication (e.g., a bisphosphonate or bisphosphonate derivative, monoclonal antibody, or parathyroid hormone analog) 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 who are diagnosed with osteoporosis
Numerator: number of people in the denominator who are started on osteoporosis medications while in hospital
Data source: local data collection

Note: Patients for whom osteoporosis medications are contraindicated are excluded.

Evidence to Improve Care