Minimum Standards for the Management of Hip Fractures: The Standards

Standard 1: Orthogeriatric clinical management of each patient

• Orthogeriatric clinical management is a collaborative approach to care provided by orthopaedic and geriatric services for the care of older patients with orthopaedic disorders
• All older hip-fracture patients should be managed in a collaborative model of care by an orthopaedic surgeon and geriatrician from the time of admission.

 

Standard 2: Optimal pain management
  

• Effective pain management is a primary goal for patients with a hip fracture
• Providing a combination of two or more analgesic medications with differing mechanisms is considered best practice in older frail patients who may not tolerate opioids.

 

 

Standard 3: Surgery within 48 hours and in daytime hours (regardless of inter-hospital transfers)

• Patients should be optimised for and undergo surgery no more than 48 hours after admission
• Surgery should be conducted within standard daytime working hours, where possible.

 

 

Standard 4: Surgery is not cancelled
   
   

• Once a planned date has been identified for repair of a hip fracture, surgery should not be cancelled, unless there are exceptional circumstances.

 

Standard 5: Commencement of mobilisation within 24 hours of surgery

• Unless medically or surgically contraindicated, patients should be encouraged and supported to sit out of bed and begin mobilising within 24 hours of surgery.

 

Standard 6: Refracture prevention
 
 

• All hip fracture patients should be assessed for future fracture risk and be offered treatment for osteoporosis if clinically appropriate. 

 

Standard 7: Local ownership of data systems/processes to drive improvements in care

• IT systems and a minimum dataset should be developed to facilitate standardised collection and analysis of data.