The incidence of hip fractures is rising worldwide. Hip fracture patients with a cardiac murmur have an echocardiogram pre-operatively in our unit. We assessed the impact of obtaining a pre-operative echocardiogram on treatment of such patients, using National Confidential Enquiry into Patient Outcome and death (NCEPOD) report 2001 as gold standard. We undertook a retrospective audit of hip fracture patients (N=349) between 01/06/08 and 01/06/09. 29 patients had pre-operative echocardiogram (echo group). A computer generated randomised sample of 40 patients was generated from N, ‘non-echo’ group. Data was obtained from medical records and the Hospital Information Support System. The groups were compared using Student's t test. Age and gender distribution were similar in both groups. 29 patients had pre-operative echo. The indication for requesting an echocardiogram pre-operatively was an acute cardiac abnormality in 4 cases. 25 patients had echocardiogram for no new cardiac problem. In the latter group, the reason for requesting an echo was a cardiac murmur in 23 patients and extensive cardiac history in 2 cases. A specialist input from the cardiologist was sought in 5 cases. Most patients with aortic valve abnormality had surgery under general anaesthetic. No patient required cardiac surgery or balloon angioplasty pre-operatively. There was a significant delay to surgery in the patients who had a pre-operative echo (average 2.7 days, range 0–6 days) compared to ‘non-echo’ group (average 1.1 days, range 0–3 days), (P< 0.001). There was no significant difference in length of stay and mortality at 28 days between the two groups. We are now developing departmental guidelines for requesting echo in hip fracture patients with cardiac murmur to prevent unnecessary avoidable delay. We are developing a link with the cardiology department to expedite echocardiogram requests in hip fracture patients.