Information for consumers - Hip Fracture Clinical Care Standard

The Hip Fracture Clinical Care Standard describes the care that you can expect to receive if you have a hip fracture. Find out more about what the Standard means for consumers and other available resources.

What is a hip fracture?

The hip is a ball and socket joint where the pelvis and thigh bone (femur) meet. A hip fracture is when the thigh bone breaks near where the ball fits into the joint. Most hip fractures are caused by a fall. As people get older, they tend to lose muscle strength, balance and bone health (bones become thinner). This means that as you get older, you are more likely to fall and even a fall from a standing height can break a bone.

What the standard means for you

The Hip Fracture Clinical Care Standard contains seven quality statements describing the care that you should be offered if you have a hip fracture. Find out what the Standard says and what it means for you in the statements below. You can use this information to help you and your support people make informed decisions in partnership with your treating team.

Quality Statements

Quality statement 1 – Care at presentation

What the standard says

A person presenting to hospital with a suspected hip fracture receives care that is guided by timely assessment and management of medical conditions, including cognition, pain, nutritional status and frailty. Arrangements are made according to a locally endorsed hip fracture pathway.

What this means for you

When you arrive at hospital, the clinical team will assess you to see if you have a hip fracture (broken hip). They will also check any other health conditions so that you can have an operation quickly if you need one. As part of the assessment, you will need an X-ray and blood tests. Your clinician will:

Check your overall health and ability to function before your injury
Ask about any existing health conditions you may have
Ask about any medicines that you are taking that may affect your surgery
Make sure your pain is controlled
Talk to you about possible reasons for your fall
Check for any problems you may be having with your memory, thinking or communication that could mean you are at risk of delirium (a serious condition where there is a change in mental state that alters awareness, such as seeing or hearing things)
Ask if you identify as Māori or Aboriginal and Torres Strait Islander, or need access to a translator.

Your priorities and choices are important, and your clinical team will support these wherever possible. Let them know if there are family members, friends or carers that you would like to have included in decisions about your care.

Quality statement 2 – Pain Management

What the standard says

A patient with a hip fracture is assessed for pain at the time of presentation to the emergency department and regularly throughout their acute admission. Pain management includes appropriate multimodal analgesia, and incorporates peripheral nerve blocks unless contraindicated.

What this means for you

If you have a hip fracture and come to the hospital by ambulance, you may be given medicines to relieve your pain and nausea in the ambulance. When you arrive at the hospital, a doctor, nurse or other clinician will assess your pain immediately and give you suitable medicines to relieve your pain. Your pain will be assessed and managed throughout your hospital stay. Before surgery, you are likely to be offered an injection in the groin called a ‘nerve block’. Nerve blocks can provide pain relief for several hours by numbing the area around your hip and thigh.

If you need to travel to another hospital for surgery, you will be given pain relief before you are transferred, to make you as comfortable as possible.

Quality statement 3 – Orthogeriatric model of care

What the standard says

A patient with a hip fracture is offered treatment based on an orthogeriatric model of care as defined in the Australian and New Zealand Guideline for Hip Fracture Care. Coordinated orthogeriatric and multidisciplinary review includes assessment and management of malnutrition, frailty, cognitive impairment and delirium.

What this means for you

If you have a hip fracture, you and your family or carer are involved in important decisions about your care from the time you are admitted to hospital. This includes working out what you would like to achieve from your care, and the best way to achieve it. For example, extra steps may need to be taken so that it is medically safe for you to have surgery or there may be different options for your surgery. Your care will be shared between healthcare providers with different areas of expertise which may include:

Specialist medical
Nursing or allied health knowledge in caring for older people
Orthopaedic (bone) surgery
Rehabilitation medicine
Physiotherapy
Nutrition.

It is important that all of your health issues are taken into account, to give you the best chance of full recovery.

Nutrition is very important to your recovery from a hip fracture. You will be assessed early in your admission to see if you are malnourished. You will be offered oral nutrition supplements to help increase your calorie and protein intake. If your clinician thinks you are malnourished, or at risk of malnutrition, they will discuss how to improve your nutrition taking into account your needs and preferences.

There is a chance you may develop a condition called delirium after a hip fracture. Delirium causes mental and physical changes such as confusion, sleepiness or agitation, and seeing or hearing things that are not there. You will be monitored for delirium throughout your hospital stay. It is important for you and your support people to let your healthcare team know about any changes in your mental awareness, including confusion, being disoriented or memory problems. Dealing with the causes of delirium quickly will help your recovery.

Quality statement 4 – Timing of surgery

What the standard says

A patient with a hip fracture receives surgery within 36 hours of first presentation to hospital.

What this means for you

Your clinicians will discuss the treatment options for your hip fracture, and the possible risks and benefits with you. You should have surgery within 36 hours of presenting to hospital with a hip fracture, unless your doctors advise that you wait. The same timeframes apply if you experience a hip fracture while you are in hospital. If you are in a remote location, surgery may be delayed while you are transferred to a hospital where the surgery can be done. However, you should still receive surgery as soon as possible.

For some people a decision is made that surgery is not the best option. You may not want to have surgery, or your doctors may advise that it is better for you not have surgery at all. Your family will be involved in these decisions.

Quality statement 5 – Mobilisation and weight bearing

What the standard says

A patient with a hip fracture is mobilised without restrictions on weight bearing starting the day of, or the day after surgery, and at least once a day, according to the patient’s clinical condition and agreed goals of care.

What this means for you

The aim of hip fracture surgery is to allow you to get up and put weight through your leg straight away. The day of your surgery or the day after your surgery, you will be encouraged to sit out of bed and start to walk using your full weight, unless there are good reasons for you not to. It is common to feel some pain or weakness when you start walking. Starting to move early will prevent you from losing your strength and mobility, and help you regain your independence sooner. It will also help to avoid serious complications, such as pneumonia, clots in the legs, pressure injuries to the skin and delirium.

If you are spending long periods in bed or in a chair without moving, you are at risk of developing a pressure injury. Your risk of getting a pressure injury will be assessed regularly and you will be provided with the right kind of equipment (like a mattress and/or cushion) and advice on moving about to relieve the pressure that causes the sores.

Quality statement 6 – Minimising risk of another fracture

What the standard says

Before a patient leaves hospital after a hip fracture, they receive a falls and bone health assessment and management plan, with appropriate referral for secondary fracture prevention.

What this means for you

People who have had a hip fracture are more likely to have another fracture in the future. Before you leave hospital, your risk of having another fracture anywhere in your body will be assessed. Your clinician will help to identify the possible reasons for your fall and ways to prevent future falls. They will also check the strength of your bones, which may be getting weaker and more likely to break easily. You may be offered bone protection medicines to improve your bone strength and reduce the chance of another fracture. You will also be given written information and advice on exercises to reduce your risk of falls or another fracture. It’s important that you continue to work on preventing another fracture after you leave hospital. Discuss your care plan with your general practitioner or ongoing clinical provider. You may be offered a follow up appointment at the hospital as part of planning to reduce your risk of another fracture.

Quality statement 7 – Transition from hospital care

What the standard says

Before leaving hospital, an individualised care plan is developed in discussion with the patient and their family or support person, that describes their goals of care and ongoing care needs. The plan includes mobilisation activities and expected function post-injury, wound care, pain management, nutrition, fracture prevention strategies, changed or new medicines and specific rehabilitation services and equipment. This plan is provided to the patient, and communicated with the patient’s general practice and other ongoing clinicians and care providers on discharge.

What this means for you

Before you leave hospital, your doctor will talk with you about your recovery and the ongoing care you will need. They will help to develop a plan with you in a format that you understand. The plan describes:

Medicines you may need to take
Information on how to prevent future fractures
Nutrition care
Rehabilitation services and equipment you require.

You will get a copy of your plan before you leave hospital. The information in your plan will also be communicated to your general practitioner and other regular clinicians and care providers. Take your plan with you to future appointments along with any questions you would like to discuss.

Useful resources

Guide for consumers - Hip Fracture Clinical Care Standard

2023

Fact sheet or brochure

Further information for consumers can also be found on the ANZHFR 'My Hip My Voice' page including the 'Hip Fracture Care Guide' resource which has been translated into 15 different languages, and was developed to help consumers understand what to expect when admitted to hospital with a broken hip.

Find more in our resource library

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