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Indicator Metadata

NameWait Times for Hip Fracture Repair: From ED Registration (Percentiles)
Short/Other Names

Not applicable

DescriptionThe number of hours patients waited, from the time of first registration in an emergency department (ED) with a hip fracture (index admission) to the time that patients received hip fracture repair surgery
Interpretation

50th percentile means a time period that typical patients have to wait to receive care.

90th percentile means that provinces could treat 90% of patients within that time period.

HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Geographic Coverage

Newfoundland and Labrador, Ontario, Alberta

Reporting Level/Disaggregation

Province/Territory

Indicator Results

http://waittimes.cihi.ca/All/fracture

Identifying Information
NameWait Times for Hip Fracture Repair: From ED Registration (Percentiles)
Short/Other Names

Not applicable

Indicator Description and Calculation
DescriptionThe number of hours patients waited, from the time of first registration in an emergency department (ED) with a hip fracture (index admission) to the time that patients received hip fracture repair surgery
Calculation: 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).

Percentiles are obtained by calculating

1. The number of hours after which half of patients received surgery and half were still waiting (50th percentile or median)

2. The number of days after which 90% of patients received surgery and 10% were still waiting (90th percentile)

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:

a) 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

b) 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.

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Number - 50th percentile, 90th percentile

Calculation: Adjustment Applied

None

Calculation: Method of Adjustment

Not applicable

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. a. 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

b. 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

c. 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 1 (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:*

a. 1.VA.74.^^ Fixation, hip joint

b. 1.VA 53.^^ Implantation of internal device, hip joint

c. 1.VC.74.^^ Fixation, femur

d. 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:
Not applicable

Background, Interpretation and Benchmarks
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

50th percentile means a time period that typical patients have to wait to receive care.

90th percentile means that provinces could treat 90% of patients within that time period.

HSP Framework Dimension

Health System Outputs: Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Targets/Benchmarks

Within 48 hours

References

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

Availability of Data Sources and Results
Data Sources

DAD, NACRS, Provincial Wait Times Registry

Available Data Years

Type of Year:
Fiscal
First Available Year:
2009
Last Available Year:
2017

Geographic Coverage

Newfoundland and Labrador, Ontario, Alberta

Reporting Level/Disaggregation

Province/Territory

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Wait Times
URL: http://waittimes.cihi.ca/All/fracture

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.

Quality Statement
Caveats and Limitations

There may be some limitations in terms of comparability of wait time data each year. Open-year data may not contain complete provincial submissions to CIHI. For more information, visit the Wait Times website (http://waittimes.cihi.ca/procedure/fracture?level=emergency#year) or see the technical notes document (https://secure.cihi.ca/free_products/WaitTimesTechnicalNotes_EN.pdf).

Trending Issues

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

Comments

Not applicable