Introduction: Hip fractures affect over 30,000 Canadians each year. Delirium, or acute confusion, occurs in up to 62% of patients following a hip fracture. Delirium substantially increases hospital length of stay and doubles the risk of nursing home admissions and death. Previous studies have shown that regional anesthesia is the optimal pain management strategy for hip fracture patients and has been shown to independently reduce the rate, severity and duration of delirium. However, very few emergency physicians (EPs) have the necessary training and experience to use regional anesthesia for hip fracture in the emergency department (ED). The objective of this study was to determine the number of femoral nerve blocks performed within the ED for the management of hip fracture patients. Methods: This was a retrospective chart review of patients aged 65 years and older, presenting to an academic ED (annual census 60,000) with a discharge diagnosis of hip fracture from January 1st 2014 to July 31st 2015. Results: Of the 243 hip fractures included in this study, mean (SD) age was 82.9 (8.2) years and 187 (77.0%) were female. The majority (214, 88.1%) of patients arrived to the ED by ambulance and 182 (74.9%) were categorized as CTAS 3. The most common analgesics used in the ED were intravenous (IV) hydromorphone (51.4%), IV morphine (32.1%), or dual therapy with both IV hydromorphone and IV morphine (4.9%). Femoral nerve blocks were initiated for 13 (5.3%) patients and successfully completed in 12 (4.9%) patients in the ED. Median (IQR) ED and hospital length of stay was 5.0 (3.7, 6.6) hours and 6.0 (4.1, 10.2) days, respectively. Forty-three (17.7%) patients experienced in-hospital acute delirium. Conclusion: Despite evidence to suggest regional anesthesia may be the optimal pain management strategy for hip fracture patients, the use of femoral nerve blocks in the ED remains low. Future research should attempt to elucidate barriers to use of this procedure by emergency physicians.