CMS’s Transforming Episode Accountability Model (TEAM) will bundle payments for hip fracture repair and all related care within a 30-day episode, requiring hospitals to optimize efficiency and outcomes across the entire care continuum. This observational assessment followed 14 surgically treated hip fracture patients from emergency department presentation through discharge to identify workflow inefficiencies and improvement opportunities. Shadowing and multidisciplinary staff interviews revealed recurring delays in time-to-OR due to inconsistent clearance practices, NPO violations, and inadequate OR prioritization. Pain control varied widely, with inconsistent use of fascia iliaca blocks and catheters. Early mobility was limited by staffing shortages and lack of automatic day-one PT/OT orders. Case management engagement often occurred late, delaying discharge planning and frequently resulting in skilled nursing facility placement. Identified opportunities included standardized hip fracture pathways, earlier acute pain service involvement, automatic therapy orders, proactive discharge planning, and improved patient education materials. These findings support system-level redesign to improve hip fracture care delivery under TEAM requirements.