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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.

Health Quality Ontario thanks the following individuals for their generous, voluntary contributions of time and expertise to help create this quality standard:

James P. Waddell (co-chair)
Orthopaedic Surgery
St. Michael’s Hospital
Professor, Division of Orthopaedic Surgery,
University of Toronto

Rhona McGlasson (co-chair)
Musculoskeletal Care and Rehabilitation
Executive Director,
Bone and Joint Canada

Nancy Della Maestra
Orthopaedics and Urology
Nurse Manager,
Surgical Unit and Fracture and Orthopaedic Clinic,
St. Joseph’s Healthcare Hamilton

Patricia G. Dickson
Occupational Therapy
Holland Musculoskeletal Program,
Sunnybrook Health Sciences Centre

Kurt Droll
Orthopaedic Surgery
Thunder Bay Regional Health Sciences Centre
Program Director, Orthopaedic Surgery and Assistant Professor,
Northern Ontario School of Medicine

Norman Ferguson
Lived Experience Advisor

Susan Jaglal
Research and Epidemiology
Vice-Chair, Research, and Professor,
Department of Physical Therapy,
University of Toronto

Ravi Jain
Director, Ontario Osteoporosis Strategy,
Osteoporosis Canada

Helen A. Johnson
ESC LHIN Rehabilitation Lead,
Chatham–Kent Health Alliance

Christopher Jyu
Primary Care Family Physician,
Scarborough and Rouge Hospital

Hans Kreder
Orthopaedic Surgery
Chief, Head Orthopaedics,
Sunnybrook Health Sciences Centre

Charissa Levy
Rehabilitation Executive Director,
Rehabilitative Care Alliance
Executive Director,
GTA Rehab Network

Nick Lo
Staff Anaesthesiologist,
St. Michael’s Hospital
Assistant Professor, Department of Anesthesia,
Faculty of Medicine,
University of Toronto

David Mackinnon
Emergency Medicine
Deputy Chief,
Emergency Department,
Trauma Team Leader,
St. Michael’s Hospital Department of Family and Community Medicine,
University of Toronto

Anne Marie MacLeod
Operations Director,
Holland Musculoskeletal Program,
Sunnybrook Health Sciences Centre

Brian Vincent McGoey
Orthopaedic Surgery, Trillium Health Partners

Janet Legge McMullan
Home and Community Care Clinical Program Lead,
Client Services,
Ontario Association of Community Care Access Centres

Gordon Nevils
Lived Experience Advisor

Jennifer Rowe
Physiotherapy Clinical Practice Leader,
CBI Home Health

Perry Rush
Physical Medicine and Rehabilitation Internal Medicine

David Sanders
Orthopaedic Surgery
London Health Sciences Centre
Professor, Orthopaedic Surgery,
Western University

Nikhil Shah
Family Medicine
Assistant Professor,
Department of Family Medicine,
Queen’s University

Lily Spanjevic
Geriatrics, Clinical Nurse Specialist, Joseph Brant Hospital

Carolan Thayer
Primary Care
Nurse Practitioner,
Lakehead Nurse Practitioner–Led Clinic

Ellen Valleau
Social Work
Social Worker in Trauma and Orthopaedics,
Sunnybrook Health Sciences Centre

Sarah Ward
Orthopaedic Surgery
Orthopaedic Surgeon,
St. Michael’s Hospital
Lecturer, Department of Surgery,
University of Toronto

Camilla Wong
Geriatric Medicine
St. Michael’s Hospital,
Assistant Professor, Faculty of Medicine,
University of Toronto

Maria L. Zorzitto
Geriatric Medicine
Division Head of Geriatrics,
St. Michael’s Hospital

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