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

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.

Background

Patients who have experienced a hip fracture are at risk for developing delirium. Hip fracture patients with delirium are more likely to have a longer hospital stay, fall, develop pressure sores, and die than those without delirium. If delirium develops, it is important to identify and manage the underlying cause or combination of causes and to attempt to treat the delirium. Interventions to prevent delirium and to promote recovery from delirium include orienting the patient to person, place, and time (involving family, caregivers, and friends when possible); creating an environment that provides context (e.g., with a window or clock) and contains familiar items, such as pictures or personal belongings; ensuring patients are using their glasses or hearing aids as appropriate; speaking to patients in a calm, reassuring voice; and considering alternatives to or the more judicious use of drugs that may either cause or exacerbate delirium.

What This Quality Statement Means

For Patients

You should be assessed for delirium (confused thinking and reduced awareness) while you’re in the emergency department and twice a day while you’re in the hospital, after any move to a new setting, and if there is a change in your medical status.

For Clinicians

Screen your hip fracture patient for delirium during their initial assessment and prior to the administration of pain medication and surgery. Perform subsequent delirium screenings at least once every 12 hours while the patient is in hospital, after transitions between settings, and upon any change in medical status. It is important to attempt to prevent delirium by orienting your patient to person, place, and time (involving family, caregivers, and friends when possible); creating an environment that provides context (e.g., with a window or clock) and contains familiar items, such as pictures or personal belongings; ensuring that patients are using their glasses or hearing aids as appropriate; speaking to patients in a calm, reassuring voice; and considering alternatives to or the more judicious use of drugs associated with delirium.

For Health Services

Ensure that your facility has validated delirium assessment tools and a policy or protocol in place for preventing and managing delirium.

Quality Indicators

Process Indicators

Percentage of hip fracture patients who are assessed for delirium with a validated tool 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 are assessed for delirium with a validated tool within 8 hours of first arrival at any hospital
Data source: local data collection

Percentage of hip fracture patients who are assessed for delirium with a validated tool after a change in medical status

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture who experience a change in medical status
Numerator: number of people in the denominator who are assessed for delirium with a validated tool every 12 hours
Data source: local data collection

Percentage of hip fracture patients who are assessed for delirium with a validated tool after transitioning to a new medical setting

Denominator: total number of adults admitted to hospital with a primary diagnosis of fragility hip fracture who are transitioned to a new setting
Numerator: number of people in the denominator who are assessed for delirium with a validated tool every 12 hours
Data source: local data collection

Percentage of hip fracture patients who are assessed for delirium with a validated tool every 12 hours while in 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 are assessed for delirium with a validated tool every 12 hours while in hospital
Data source: local data collection

Structural Indicator

Percentage of hospitals that have a policy or protocol in place to prevent and manage delirium

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

Evidence to Improve Care