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Following implementation of a hip fracture protocol the number of patients admitted to a surgical service increased from 198 (76%) to 348 (94%, p less then 0.005) with the number of patients being admitted to a monitored setting increasing from 40 (15%) to 83 (22%, p = 0.026). The time to surgery was reduced to 2.75 days (p = 0.054). The complication rate fell from 23% to 4% (p less then 0.0005). Length of stay was significantly reduced from 13.2 days to 12 days (p = 0.045). CONCLUSIONS A hip fracture protocol including admission to a mo