Wait Times for Hip Fracture Repair: From ED Registration (Percentage Meeting Benchmark)

Percentage of patients within a province who received a hip fracture repair within 48 hours of the time of first registration in an ED with a hip fracture (index admission)

The greater the percentage meeting the benchmark, the greater the proportion of patients in that province who received treatment within the benchmark (48 hours).

Data updated:
Data availability: to (fiscal years)
Geographic coverage
Newfoundland and Labrador, Prince Edward Island, Ontario, Alberta
Reporting level
Province/Territory
Calculation

This indicator is calculated based on National Ambulatory Care Reporting System (NACRS), Discharge Abstract Database (DAD) and provincial wait time data for the first 2 quarters of the fiscal year (April 1 to September 30).

Percentage meeting benchmark is calculated by dividing the number of patients who received care within the benchmark timeframe by the total number of patients receiving care.

Unit of Analysis: Episode of care

An episode of care refers to all contiguous inpatient hospitalizations where the patient was first registered in an emergency department (ED). If more than one ED episode is linked to a single acute hip fracture episode, then the ED episode with the earliest entry date/time (index admission) is selected. Only acute care episodes that began between 24 hours before and 12 hours after the patient is recorded as leaving the ED are included.

For acute care episodes with transfers between facilities, transfers are linked regardless of diagnoses. Abstracts for the same patient are linked as part of the same episode when one of the following is true:

  1. An acute care hospitalization occurs less than 7 hours after discharge from the previous acute care hospitalization, regardless of whether the transfer is coded; or
  2. An acute care hospitalization occurs between 7 and 12 hours after discharge from the previous acute care hospitalization, and at least one of the hospitalizations has coded the transfer.

Wait time is calculated in hours from the episode start date/time (initial ED registration) to the procedure date/time of the hip fracture surgery.

Denominator

The number of hip fracture episodes among patients age 18 and older that were surgically treated in an acute care hospital

Numerator

A subset of the denominator that represents the number of hip fracture episodes in which patients were surgically treated within 48 hours of initial admission to the ED

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Name

Wait Times for Hip Fracture Repair: From ED Registration (Percentage Meeting Benchmark)

Short/Other Names

Not applicable

Description

Percentage of patients within a province who received a hip fracture repair within 48 hours of the time of first registration in an ED with a hip fracture (index admission)

Rationale

In 2004, Canada's first ministers agreed to work toward reducing wait times for five priority areas: cancer treatment, cardiac care, diagnostic imaging, joint replacement and sight restoration. CIHI was mandated to collect wait time information and monitor provincial progress in meeting benchmarks.

Many factors affect wait times, for example, availability of resources, efficiency of a particular facility, seasonal effects, volumes, patient choice, patient condition, follow-up care and/or treatment complexity.

This indicator can be used to understand access to care and to know how provinces are performing in terms of providing access to services.

Interpretation

The greater the percentage meeting the benchmark, the greater the proportion of patients in that province who received treatment within the benchmark (48 hours).

HSP Framework Dimension

Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Targets/Benchmarks

Within 48 hours

Available Data Years

to

Geographic Coverage

  • Newfoundland and Labrador
  • Prince Edward Island
  • Ontario
  • Alberta

Reporting Level/Disaggregation

  • Province/Territory

Indicator Results

Explore wait times for priority procedures across Canada

Update Frequency

Every year

Latest Results Update Date

Updates

Hip fracture diagnosis must now appear in the index and surgical acute abstracts. Hip fracture must now be the main pre-admit condition in the index hospitalization. Minor changes were made to the episode-building methodology.

Description

This indicator is calculated based on National Ambulatory Care Reporting System (NACRS), Discharge Abstract Database (DAD) and provincial wait time data for the first 2 quarters of the fiscal year (April 1 to September 30).

Percentage meeting benchmark is calculated by dividing the number of patients who received care within the benchmark timeframe by the total number of patients receiving care.

Unit of Analysis: Episode of care

An episode of care refers to all contiguous inpatient hospitalizations where the patient was first registered in an emergency department (ED). If more than one ED episode is linked to a single acute hip fracture episode, then the ED episode with the earliest entry date/time (index admission) is selected. Only acute care episodes that began between 24 hours before and 12 hours after the patient is recorded as leaving the ED are included.

For acute care episodes with transfers between facilities, transfers are linked regardless of diagnoses. Abstracts for the same patient are linked as part of the same episode when one of the following is true:

  1. An acute care hospitalization occurs less than 7 hours after discharge from the previous acute care hospitalization, regardless of whether the transfer is coded; or
  2. An acute care hospitalization occurs between 7 and 12 hours after discharge from the previous acute care hospitalization, and at least one of the hospitalizations has coded the transfer.

Wait time is calculated in hours from the episode start date/time (initial ED registration) to the procedure date/time of the hip fracture surgery.

Type of Measurement

Percentage or proportion

Denominator

Description:

The number of hip fracture episodes among patients age 18 and older that were surgically treated in an acute care hospital

Inclusions:

  1.  
    1. Hip fracture ICD-10-CA code S72.0, S72.1 or S72.2 is coded as most responsible diagnosis (MRDx) but not also as diagnosis type (2); or
    2. Another diagnosis is coded as MRDx and also as type (2), and a diagnosis of hip fracture is coded as diagnosis type (1) or (W), (X), (Y) but not also as diagnosis type (2); or
    3. Convalescence or rehabilitation ICD-10-CA code Z50.1, Z50.8, Z50.9, Z54.0, Z54.4, Z54.7, Z54.8 or Z54.9 is coded as MRDx and hip fracture is coded as diagnosis type (1) or (W), (X), (Y) but not also as diagnosis type (2).

      Note: If hip fracture surgery is not performed during the first (initial) hospitalization of the episode of care, criterion # (a, b or c above) must be met on both the initial and surgical record if transfer occurred.
  2. Criterion 1 (a, b, c) along with a relevant CCI procedure code:*
    1. 1.VA.74.^^ Fixation, hip joint
    2. 1.VA 53.^^ Implantation of internal device, hip joint
    3. 1.VC.74.^^ Fixation, femur
    4. 1.SQ.53.^^ Implantation of internal device, pelvis
  3. Age at admission: 18 years and older
  4. Sex recorded as male or female
  5. Admission to an acute care institution (Facility Type Code = 1)
  6. Admission category recorded as emergent/urgent (Admission Category Code = U)
  7. Patient is recorded as leaving the ED between 12 hours before and 24 hours after the admission to an acute care institution

Notes
*Code may be recorded in any position.

Procedures coded as out of hospital and abandoned after onset (status attribute = A or OOH indicator flag = Y) are excluded.

Exclusions:

  1. Records with an invalid health card number
  2. Records with an invalid code for province issuing health card number
  3. Cadaveric donor or stillbirth records (Admission Category Code = R or S)
  4. Records with an invalid ED admission date or time
  5. Records with an invalid discharge date or time
  6. Records with an invalid procedure date or time
  7. Potential and true duplicate ED visits
  8. Elective ED admissions
  9. Direct admissions into an inpatient facility

Numerator

Description:

A subset of the denominator that represents the number of hip fracture episodes in which patients were surgically treated within 48 hours of initial admission to the ED

Method of Adjustment

Not applicable

Adjustment Applied

None

Geographic Assignment

Place of service

Data Sources

  • DAD
  • NACRS
  • Provincial Wait Times Registry

Caveats and Limitations

There might be some limitations in comparability of wait time data each year. Open-year data may not contain complete provincial submissions to CIHI. For details, please see the Trend tab of CIHI’s wait time visualization or see the methodology notes (PPTX). 

Trending Issues

There is a new methodology starting with the 2017 data year that mainly affects surgical volumes.

Comments

Not applicable

References

Health Canada. A 10-Year Plan to Strengthen Health Care. Updated September 16, 2004. Accessed June 7, 2013.

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