Bone and Joint Health Network
A Ontario program to improve care for hip fracture patients 

Rhona McGlasson, Project Director
Janet McMullan, Project Manager
Bone and Joint Health Network, Ontario

The Orthopaedic Expert Panel was established in April 2008 by the Ontario Wait Times Strategy to improve orthopaedic care across the province. Through 2008 and 2009, the Bone and Joint Health Network has been working with the Orthopaedic Expert Panel to facilitate knowledge translation and assist regions and health service providers to increase access and improve care for hip fracture patients. Benefits for people across Ontario include shorter waits for surgery and improved clinical practices across the health care continuum.

As part of this mandate, a comprehensive model of care for hip fracture care was developed using a consensus-building approach that brought together knowledge and experience from across the province. The hip fracture model of care focuses on increasing patient flow through the system including reducing surgery wait times to less than 48 hours and provides earlier access to inpatient rehabilitation for all patients that are medically stable regardless of cognitive impairment. This model ensures patients coming from the community will receive access to rehabilitation and for many patients, this means an opportunity to return to their pre-fracture living environment.

The Bone and Joint Health Network has also been working on creating a series of comprehensive resources in the form of a Toolkit to support the new hip fracture model of care. For example, the Bone and Joint Health Network has put together resource materials to improve clinical management of patients through care maps; pre and post surgery order sets; prevention, screening and management tools for delirium and dementia; pain management protocols, and patient family education tools. There has also been a discussion paper "Improving Functional Recovery After Hip Fracture Surgery" written to provide guidelines on surgery practice to allow patients to fully weight bear following surgery. The Bone and Joint Health Network is also working closely with Osteoporosis Canada and Safer Healthcare Now to promote their clinical programs for osteoporosis detection and treatment as well as appropriate post fracture anticoagulation for hip fracture patients. All the tools and materials are designed to help organizations provide and coordinate the spectrum of care that is required to improve the outcomes for older patients.

Finally, a reporting template and reporting system has been created to monitor organizational and regional performance with hip fracture care on a quarterly basis using data from the Canadian Institute for Health Information (CIHI) which is currently in use by some of Ontario's leading orthopaedic centres.  

Dr. James P. Waddell, Chair of the Orthopaedic Expert Panel, states "the efforts of the Expert Panel and BJHN are truly enabling improvement in clinical practices through knowledge translation and sharing, and are resulting in access and improved orthopaedic care for people across Ontario."  

If you have any questions about the Bone and joint Health Network or would like to receive information on any of our resource materials, please feel free to contact Dr. James P. Waddell, Chair of the Orthopaedic Expert Panel, at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or Rhona McGlasson, Project Director of the Bone and Joint Health Network at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .