Hip Fracture - Quality Statement 1: Emergency Department Management

Resources Quality Statements Advisory Committee About

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.

Background

To reduce delays to surgery, patients with suspected hip fracture should be rapidly assessed, diagnosed, and prepared for surgery upon arrival at hospital. Once a hip fracture is diagnosed, patients should receive a preoperative assessment, including admission and transfer to an inpatient bed within 8 hours. If a patient is to be transferred to another hospital for surgery, preparations for their transfer should begin after diagnosis.

What This Quality Statement Means

For Patients

You should be seen by a doctor within 1 hour of arriving at the hospital so you can be diagnosed and receive treatment as quickly as possible. You should be transferred to an inpatient bed within 8 hours of arriving at the hospital.

For Clinicians

If you suspect that a person has a hip fracture, ensure that they are diagnosed, that preparation for surgery is initiated, and that the patient is transferred to an inpatient bed within 8 hours.

For Health Services

Ensure that systems, processes, and resources are in place to assist clinicians with the assessment of people with suspected hip fracture. This includes ensuring access to validated assessment tools, laboratory testing, necessary imaging, and areas for physical examination; providing the time required for a full assessment; and ensuring availability of trained professionals.

Quality Indicators

Process Indicators

Percentage of patients with a suspected hip fracture who have imaging (typically x-ray) and who are seen by a physician within 1 hour of arrival at hospital

Denominator: total number of adults presenting to hospital with suspected hip fracture
Numerator: number of people in the denominator who have imaging (x-ray, CT scan, or MRI) and are seen by a physician within 1 hour of arrival at hospital
Data source: local data collection

Percentage of patients with a confirmed hip fracture who are transferred to an inpatient bed within 8 hours of arrival at hospital

Denominator: total number of adults presenting to hospital with a primary diagnosis of fragility hip fracture
Numerator: number of people in the denominator who are transferred to an inpatient bed within 8 hours of arrival at hospital
Data source: local data collection

Percentage of hip fracture patients who receive initial preparation for surgery within 8 hours of arrival at hospital

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture
Numerator: number of people in the denominator who receive bloodwork, consultations (e.g., orthopaedic surgery, anaesthesia), ECG, and medication adjustment or discontinuation as needed within 8 hours of arrival at hospital
Data source: local data collection

Structural Indicator

Percentage of surgical hospitals that have a protocol, including a standardized order set, to prioritize the admission process for hip fracture patients such that they are admitted and transferred to an inpatient bed within 8 hours

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

Definitions Used Within This Quality Statement

Hip fracture diagnosis

Hip fracture diagnosis requires a clinical assessment by a physician, imaging (typically x-ray; rarely computerized tomography [CT] or magnetic resonance imaging [MRI]), and subsequent imaging interpretation to confirm the diagnosis.

Initial preparation for surgery

Further assessments may be needed once the patient is transferred out of the emergency department. Initial preparation for surgery involves the following, which should occur within 8 hours of arrival at hospital:

Baseline information and history, including pre-fracture functional status, cognitive status, and delirium screen
Bloodwork
Consultations as needed
Electrocardiography (ECG)
Medication adjustment or discontinuation as needed
Preparation for transfer if patient is to be transferred to another hospital for surgery

Evidence to Improve Care