Assessment of malnutrition This indicator is not used by the two healthcare regulators in the Netherlands. It is therefore unknown whether there is hospital variation on this indicator (unknown clinical relevancy). Oral nutritional supplementation may reduce postoperative complications, but randomized clinical trials are lacking (possibly scientifically acceptable—valid) [14]. Operation within 24 hours In the Netherlands, this indicator was used till 2012 and has been used again since 2017. Of all ASA 1–2 patients, 93% were operated on within one calendar day after admission, and one hospital only differed significantly from this nationwide average. Of the patients with an ASA score of > 2, 86% were operated within the one calendar day after admission, and four hospitals significantly differed from the nationwide average. As a result, this indicator does not detect variation between Dutch hospitals (not clinically relevant) [6]. Regarding validity, the indicator is correlated with return to pre-fracture mobility and mortality (scientifically acceptable—valid) [7]. Orthogeriatric management during admission In the Netherlands, this process indicator was used from 2014 till 2018 [15]. In 2014, the nationwide average of orthogeriatric management was 67%, and this increased to 80% in 2018, with 13 hospitals performing significantly worse than the mean [16]. An average of 80% enables to detect underperformers, but is not able to identify best performers (partly clinically relevant). In the literature, orthogeriatric management in elderly hip fracture patients is associated with fewer complications, better functional outcomes and improved 30-day and 1-year mortality rates (scientifically acceptable—valid) [17–19]. Operation by an orthopaedic trauma certified surgeon In 2017, three hospitals indicated that either an orthopaedic trauma certified surgeon or a geriatrician was not available. In 2018, this was the case in two hospitals. However, it is unknown at patient level how often both an orthopaedic trauma certified surgeon and a geriatrician is available (unknown clinical relevancy) [20]. Treatment by a trauma certified surgeon is associated with fewer reoperations and surgical site infections compared to treatment by a general surgeon (scientifically acceptable—valid) [21].