Seven strategies reveal how UK hospitals kept hip fracture care running through COVID-19

When the COVID-19 pandemic hit, UK hospitals faced an impossible balancing act: surge capacity for coronavirus patients while still treating the roughly 80,000 people who fracture a hip in the country every year. A mixed-methods study published in BMC Health Services Research has now documented how 164 UK hospitals reorganised hip fracture services during the first pandemic wave, and distilled the lessons into seven strategies that the researchers say can guide the design of resilient healthcare services in future crises.

The study, led by Sarah Drew and colleagues including Celia L. Gregson, focused on resilience at the organisational level, described in the paper as the meso level, between individual staff and the national health system. In 2020, the National Hip Fracture Database surveyed the pandemic response of 164 UK hospitals. The quantitative findings were then mapped onto 16 in-depth qualitative interviews conducted in 2021 with healthcare professionals at four diverse hospitals, using a convergent mixed-methods design that integrated the two strands of data.

The survey results show that the disruption was real but uneven. During the first UK wave of COVID-19, 17% of hospitals diverted all or part of their hip fracture intake to another hospital, yet the majority, 83%, continued to accept all presenting patients. Even where intake was preserved, the pandemic reshaped how care was delivered. The study records delayed surgery, reduced availability of orthogeriatricians, disrupted communication between team members, and the placement of patients on wards that lacked specialist hip fracture expertise.

From the interviews and survey data combined, the researchers identified seven strategies services used to adapt. The first was reallocation of material and human resources, including changes to elective surgery and staffing. The second involved trade-offs and workarounds, such as making clinical decisions without information about a patient’s COVID-19 status. The third was a reorientation of organisational goals to facilitate expedited discharge, and the fourth was the reconfiguration of physical spaces such as wards.

The remaining three strategies concerned people and information. Staff upskilling and in-situ training allowed workers to cover unfamiliar roles. Leadership and collaboration, including enabling staff to adapt care pathways themselves, helped teams respond quickly to shifting demands. Finally, services developed information transfer processes using new technologies to keep multidisciplinary communication flowing when normal channels were disrupted.

Hip fracture care is a demanding test of health system resilience. The study’s authors note that despite urgent pressure to provide care for people with COVID-19, healthcare for other conditions still had to continue, and describing how that care was adapted provides vital information for future resilient healthcare planning.

The seven strategies are presented not as a fixed prescription but as a framework for resilient multidisciplinary meso-level hip fracture care. According to the authors, the strategies can be used to refine healthcare services, complemented by audit and evaluation to understand their impacts on healthcare utilisation, costs and patient outcomes. In other words, the framework describes what services did; measuring whether those adaptations protected patients is the next step.

The study is published as open access research, with the version shared carrying a permanent DOI and subject to further editorial edits before the final version of record. Its scope is deliberately bounded: it examines UK hospital services during one pandemic wave, drawing on a national survey and interviews at four hospitals, and it addresses organisational rather than individual or system-wide resilience.

Subject of Research: How UK hospitals adapted multidisciplinary hip fracture care during the COVID-19 pandemic

Article Title: Informing future resilience of UK healthcare: a mixed methods study of hip fracture care during the COVID-19 pandemic

Article References: Drew, S., Fox, F., Holleyman, R. J., Johansen, A., Gooberman-Hill, R., & Gregson, C. L. (2026). Informing future resilience of UK healthcare: a mixed methods study of hip fracture care during the COVID-19 pandemic. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15044-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15044-6

Keywords: hip fracture, COVID-19, health services research, resilience, National Hip Fracture Database, mixed methods, orthogeriatrics, UK hospitals, multidisciplinary care, pandemic response, Informing, future