Background and Aims The COVID-19 pandemic has had huge implications on healthcare; we aimed to quantify the impact hip fracture provision at the Bristol Royal Infirmary.

Methods We undertook an interrupted time series analysis across four months, representing pre-COVID-19, the first wave, the second wave, and now. We compared the following factors: number of #NOF cases, delays to theatre, delays due to lack of theatre capacity, and length of stay. We also looked at interruptions to patient care, including ward changes and the closure of Weston General.

Results With patients in lockdown, number of #NOF were expected to reduce; there was no evidence for this.

During the first wave, the average length of stay was 11.1 days, compared to 26.0 days pre-COVID-19 (p-value 0.0016). Now, though lengths of stay are gradually increasing, they are still significantly shorter than pre-COVID-19, with an average of 17.1 days (p-value 0.04). The number of patient delays did not significantly change.

Additionally, Weston General closing increased both case numbers and delays to theatre, with cases rising from 14 to 26 (+85.7%) and delays to theatre from 5 to 17 (+240%).

Conclusions Patient stays are still shorter than pre-pandemic; whether this is a valuable lasting change will be evident in the coming months. Weston General becoming COVID-only put strains on the capacity of the BRI, demonstrated by the increased caseload and resulting theatre delays.

Several patients were significantly delayed without a medical reason: some for up to a week, despite being listed repeatedly. Prioritisation of theatre lists needs to be reviewed.