Details
Percentage of people who undergo hip fracture surgery within 48 hours of first arrival at any hospital
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People with hip fracture requiring surgery should receive surgical intervention as soon as possible, within a maximum of 48 hours of their first presentation to hospital, regardless of whether they are subsequently transferred to another hospital for surgery. Increased time to surgery causes prolongation of pain and extended hospital stays and is associated with increased morbidity and mortality.
Each year, about 12,000 people in Ontario aged 50 years and older experience a hip fracture. In FY 2022/23, one-quarter (25%) of people with hip fracture waited longer than the recommended 48 hours for surgery. Most people who had hip fracture surgery (85%) were admitted through the ED. However, those admitted through the ED had longer wait times than those admitted directly as an inpatient, with median wait times of 33 hours and 21 hours, respectively.
Key Resources
Change Ideas
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Standardize and streamline the hip fracture care pathway
- Develop clinical pathways, order sets, and medical directives to promote patient optimization for timely surgery
- Digitize the hip fracture care pathway in the EMR to support clinical teams in proactively planning for patient care along the trajectory
- London Health Sciences Centre, featured in Ontario Health’s 2024 Using Quality Standards to Improve Care: Spotlight Report on London Health Sciences Centre for its success in improving hip fracture outcomes, shares its pre-operative and post-operative hip fracture order sets
Prioritize surgery for hip fracture patients
- Prioritize hip fracture cases as B cases and escalate urgency as elapsed time approaches 42 hours
- Dedicate blocks of operating room time each day for emergency orthopaedic cases
- National Hip Fracture Toolkit , see Operating Room Priority Management
- Hip Fracture Quality Standard , see Quality Statement 2: Surgery Within 48 Hours
Review Hip Fracture Data Regularly
- Initiate regular interprofessional reviews of data on wait time to surgery for people with hip fracture to identify organizational opportunities for improvement. Potential data sources include:
Ontario Health’s Hip Fracture eReport
- For hospitals participating in ONSQIN: Collect targeted hip fracture procedure data via NSQIP to track postoperative outcomes and performance. Please contact ONSQIN@ontariohealth.ca for assistance
Power BI organizational dashboard
Build capacity to develop an interdisciplinary approach to hip fracture care quality improvement
- Identify champions to lead hip fracture quality improvement work
- Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures: A Systematic Review
- Join Project ECHO Orthogeriatrics to build interdisciplinary team capacity through education on best practices in the care of older adults who have suffered a fragility hip fracture
- ECHO Orthogeriatrics
- Develop routine interdisciplinary case conferences to systematically address holistic hip fracture patient care
- London Health Sciences Centre, featured in Ontario Health’s 2024 Using Quality Standards to Improve Care: Spotlight Report on London Health Sciences Centre for its success in improving hip fracture outcomes, shares its template for interdisciplinary case conferences on patients with hip fracture .
Last Updated: August 26, 2026
