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

Patients with a 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 and increased lengths of hospital stay. The aim of this audit was to identify the percentage of patients mobilised day one and key barriers to mobilisation which could be addressed to reduce post operative complications and duration of hospital stay.

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. Key barriers to mobilisation including delirium, pain, low blood pressure/postural drop or refusal were recorded. Postural drop was defined as a drop in systolic blood pressure of 20mmHg on attempt to mobilise.   

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%).  Of those who had a lying standing blood pressure performed, 52% had a postural drop.

North Tees Hospital remains well below the National Average for mobilisation day one post operation. The most common barrier to mobilisation is blood pressure/postural drop. Patients who are day 1 post operation are reviewed by the therapy team first in the morning. Evidence shows postural hypotension is worst earlier in the day. Mobilizing patients later in the day could reduce the incidence of postural hypotension and subsequently improve mobilisation rate.