Advancing Quality NHS Advancing Quality Alliance

Hip Fracture

Hip joints are ball-and-socket joints. The ball is the rounded top part of the femur. The socket is the cup-shaped part of the pelvic bone that the rounded end of the femur sits inside. A hip fracture is a crack or break in the top end (neck) of the femur, nearest the hip joint. It can either occur in the part of the femur inside the socket of the hip joint (intracapsular), or outside the socket (extracapsular).

NHS Choices

Through research, clinical input and clinical guidelines Advancing Quality has developed nine measures that, when applied at the appropriate time, can greatly increase the outcomes for patients. Advancing Quality uses these measures to monitor the quality of care given to patients across the North West with the aim of improving standards and reducing variation in care.

Hip Fracture was launched in October 2014. Participating trusts had a three month data collection period to ensure their systems were accurately recording the care patients received. Hip Fracture became part of the AQ conditions in January 2015.

Data for your local hospital will be available by February 2016.


1. Pain score assessment and painkillers given within 60 minutes of hospital arrival

You should have your pain scored by a validated assessment tool and receive pain relief such as paracetomal within 60 minutes of arriving at hospital.

2. Admission to appropriate specialist ward within four hours of hospital arrival

You should be admitted to an appropriate specialist ward such as orthopaedic or orthogeriatric ward within four hours of hospital arrival.

3. Jointly agreed protocol started within six hours of hospital arrival

Your hospital should have a protocol in place that means the time you have to wait for surgery is reduced. You should be placed on this protocol within six hours of arriving at hospital.

4. Pressure ulcer assessment within six hours of arrival

An assessment of pressure ulcers should be carried out within six hours of arrival at hospital.  Preventing you from developing a pressure ulcer can reduce complications during your stay in hospital.

5. Surgery supervised by Consultant or Senior Clinician

During your surgery a consultant or senior clinician should present. The presence of the consultant or senior clinician helps improve the care you receive and reduce the risk of further operations being required.

6. Post-operative notes should state that the patient should full weight bear

Your notes should state that you should fully weight bear; this early mobilisation allows for early rehabilitation and can reduce the length of your stay in hospital and reduce the risk of complications.

7. Physiotherapy assessment within 24 hours of surgery

You should have a physiotherapy assessment completed within 24 hours of your surgery ending; this will assist your recovery and can reduce your length of stay.

8. Nutritional screening within 24 hours or arrival

Having a nutritional assessment within 24 hours of hospital arrival ensures that you do not become malnourished. Ensuring you are not malnourished can reduce your length of stay and the risk of developing complications.
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