A closed loop audit analysing the number of patients who are mobilised day one post hip operation and key barriers to mobilisation​

Patients with hip fracture should start rehabilitation no later than the day after their operation (NICE Quality Statement). Only 69% of patients with a hip fracture were mobilised day one post operation in 2025 in North Tees Hospital putting it in the lowest performing quartile in the United Kingdom. Delayed mobilisation is shown to increase the risk of post operative complications such as pulmonary embolism and lower respiratory tract infections along with increasing lengths of hospital stay associated with increased risk of morbidity and mortality within the geriatric population. 

The aim of this audit was to identify the percentage of patients mobilised day one and key barriers to mobilisation. Following the first cycle key barriers were addressed and measures put in place to increase the potential for mobilisation day one. The ultimate goal is for this to reduce post operative complications, reduce the length of hospital stays and improve patient care (NICE quality statement). 

A prospective study was carried out across a two-month period of January to February 2026 including a total of fifty patients. The standards used were from the National Hip Fracture Database which states patients should be mobilised on day one. Mobilised was defined as “bottom off the bed” without the use of a hoist. Adverse outcomes including prevalence of post-operative complications such as pulmonary embolism and respiratory tract infections were measured along with the total length of hospital stay. Key barriers to mobilisation including delirium, pain, low blood pressure/postural drop or refusal were recorded to identify opportunities to increase the number of patients mobilised on day one. Postural drop was defined as a drop in systolic blood pressure of 20mmHg on attempt to mobilise. Other components measured included the method of operation, anaesthetic used, time from admission until surgery and whether a nerve block was administered in A&E or not. 

Only 70% of patients were mobilised day one compared to the national average of 82%. The main barrier to mobilisation identified was low blood pressure (40%) and delirium (27%).

The therapy team were reviewing day one post operation patients first in the morning. Evidence has shown blood pressure is lowest in the morning. The time for therapy review was changed to later in the day allowing the medical team to assess fluid status and prescribe fluids if appropriate. A second cycle was then completed which showed an improvement of mobilisation rates from 70% to 80%. Furthermore blood pressure was not a barrier for a single patient mobilising in the second cycle (down from 40% to 0%).

This closed loop audit has significantly improved mobilisation rates and patient care. Identifying the key barriers to mobilising has enabled measures to be put in place to optimise the perioperative care of the geriatric population.