Quality Standard Details
Hip Fracture: Care for People With Fragility Fractures
- Publication Date
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2024-February-01
- Status
- Published
- Topic Area
- Bones, Joints and Muscles
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People who experience fragility hip fractures are typically older and living with osteoporosis and a variety of other comorbidities. About 12,000 people living in Ontario experience a hip fracture every year. Roughly 20% of these people will die within a year of their fracture; another 20% who had been independent before their fracture will be admitted to long-term care; and less than half of those who had previously been living independently will be able to walk without aids following the fracture.
The health care expenditures associated with hip fracture are substantial, accounting for nearly $500 million of health care spending per year in Ontario. There is considerable variation in the quality of hip fracture care in Ontario.
This quality standard focuses on adults aged 50 years and older undergoing surgery for fragility hip fractures and the care delivered from the point at which they present to the emergency department until 3 months following surgery. Fragility hip fractures are fractures of the femur caused by low-energy trauma, such as falls from a standing height. This quality standard does not apply to people with hip fractures resulting from high-energy trauma or people with fragility fractures who are not candidates for surgery.
Quality Standard in Brief
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Quality Statement 1: Emergency Department Management
People with suspected hip fracture are diagnosed within one hour of arriving at hospital. Preparation for surgery is initiated, and they are admitted and transferred to a bed in an inpatient ward within eight hours of arriving at hospital.
Quality Statement 2: Surgery Within 48 Hours
People with hip fracture receive surgery as soon as possible, within 48 hours of their first arrival at any hospital (including any time spent in a nonsurgical hospital).
Quality Statement 3: Multimodal Analgesia
People with suspected hip fracture have their pain assessed within 30 minutes of arriving at hospital and managed using a multimodal approach, including consideration of nonopioid systemic analgesics and peripheral nerve blocks.
Quality Statement 4: Surgery for Stable Intertrochanteric Fractures
People diagnosed with a stable intertrochanteric fracture are treated surgically with a sliding hip screw or cephalomedullary nail.
Quality Statement 5: Surgery for Subtrochanteric or Unstable Intertrochanteric Fractures
People diagnosed with a subtrochanteric fracture or unstable intertrochanteric fracture are treated surgically with an intramedullary nail.
Quality Statement 6: Surgery for Displaced Intracapsular Fractures
People diagnosed with a displaced intracapsular fracture are treated surgically with arthroplasty.
Quality Statement 7: Postoperative Blood Transfusions
People 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
People with hip fracture are mobilized to weight-bearing as tolerated within 24 hours following surgery.
Quality Statement 9: Daily Mobilization
After surgery, people with hip fracture are mobilized on a daily basis to increase their functional tolerance.
Quality Statement 10: Screening for and Managing Delirium
People with hip fracture are screened for delirium using a standardized, 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. They receive interventions to prevent delirium and to promote recovery if delirium is present.
Quality Statement 11: Postoperative Management
People with hip fracture receive postoperative care from an interprofessional team in accordance with principles of geriatric care.
Quality Statement 12: Information for Patients, Families, and Care Partners
People with hip fracture and their families and care partners are given information on patient care that is tailored to meet their needs and delivered at appropriate times in the care continuum.
Quality Statement 13: Rehabilitation
People with hip fracture participate in an interprofessional rehabilitation program (in an inpatient setting, a community setting, or a combination of both) with the goal of returning to their prefracture functional status.
Quality Statement 14: Osteoporosis Management
While in hospital, people with hip fracture undergo a fracture risk assessment from a clinician with osteoporosis expertise and, when appropriate, are offered medications for osteoporosis.
Quality Statement 15: Follow-Up Care
People with hip fracture are discharged from inpatient care with a scheduled follow-up appointment with a primary care provider within two weeks of discharge and a scheduled follow-up appointment with the orthopaedic service within 12 weeks of their surgery.
Supporting Documents
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Patient guide for this quality standard
Know what to ask for in your care
Placemat for this quality standard
A quick-reference resource for clinicians that summarizes the quality standard and includes links to helpful resources and tools
Quality standard implementation toolkit
Quality improvement tools and resources for health care professionals, including an action plan template
Supplementary information to support the data collection and measurement process
The eReport is an online tool for hospitals. It allows you to access indicators that help enable quality improvement. The report is dynamic, and you can view data at the hospital and regional levels. You will need a ONE ID account to access the data.
Additional Resources
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- Case for improvement (slide deck)
Share why this standard was created and the data behind it, to get the support you need to put it into practice - Technical specifications
See the technical specifications for the indicators within the quality standard - Spotlight report and infographic
Know what successful quality standard implementation looks like, based on examples from the field - Summary of the public feedback we received
- Case for improvement (slide deck)
Last Updated: February 24, 2026
