Hip Fracture Clinical Care Standard

A hip fracture is a break occurring at the top of the thigh bone (femur), near the pelvis. Hip fracture is an event that often signifies underlying ill health. Most hip fractures occur in people aged 65 years and over, with an average age of 82 years across Australia and New Zealand Aotearoa. Individuals with hip fracture are over 3.5 times more likely to die within 12 months compared to non-injured individuals. This patient group also has a high hospital-acquired complication rate, resulting in patient suffering and unnecessarily high healthcare costs.

Key markers of quality of care in hip fracture such as time to surgery, complication rates, hospital readmission rates and length of stay can vary considerably between hospitals. Hip fracture patients, being vulnerable due to their age, are at risk of other common hospital-acquired complications such as those defined by the Commission. The quality of care is influenced by, among other factors, the configuration of orthopaedic and geriatric medicine services, hospital protocols and processes, and the degree to which a multidisciplinary approach to care is taken.

These considerations were fundamental to the development of the Hip Fracture Clinical Care Standard.

The standard was first published in 2016.

Changes were made in 2023 to align the quality statements and indicators with the evidence base and current practice. Key updates in the current version include:

• The addition of cultural safety and equity considerations
• Changes to
  • Quality statements 1 and 3 - to include assessment and management of delirium, nutrition and frailty
  • Quality statement 2 - to include the use of nerve blocks, and to align with the care described in the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard
  • Quality statement 4 - to reduce the time to surgery from 48 hours to 36 hours
  • Amendments to the indicators, including new, retired and changed indicators.

Can I still use the existing standard?

The revised clinical care standard maintains the same scope and goal of the 2016 Hip Fracture Clinical Care Standard. It is recommended that services use the 2023 version of the clinical care standard no later than September 2024, 12 months from the release of the updates standard. 

The goal of the hip fracture clinical care standard is to improve the assessment and management of people with a hip fracture to optimise outcomes and reduce their risk of another fracture. 

The Hip Fracture Care Clinical Care Standard provides advice to clinicians, consumers and health services on key components of care including:

• Care at presentation
• Pain management
• Orthogeriatric model of care
• Timing of surgery
• Mobilisation and weight-bearing
• Minimising risk of another fracture
• Transition from hospital care.

The process for revising the Standard has included consultation with the Hip Fracture Clinical Care Standard Topic Working Group, a targeted consultation process with potential endorsing organisations and internal review through the Commission’s processes.

The Standard has been endorsed by a number of key organisations.

Further information is available on the evidence base which underpins the Hip Fracture Clinical Care Standard.