Date post: | 16-Feb-2017 |
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Preventing Future Fractures
Implementing a FractureLiaison Service
Wednesday 16th March 2016
Sonya Stephenson Service Development Manager / Specialist Nurse
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• T&O• Rheumatology• Fracture Liaison
Service• National Osteoporosis
Society (NOS)
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Introduction
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• 300,000 fragility fractures
• 85,000 are hip fracture• 1.8m hospital bed days• 1 month post hip
fracture 1 in 13 patients will have died and only half will have gone home
• £1.9bn hospital costs
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Impact of Fractures in the UK
What is the solution?
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FLS - to ensure the first fracture is the last!
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Definition of an FLS‘‘A Fracture Liaison Service (FLS) systematically
identifies, treats and refers to appropriate services all eligible patients aged over 50 years within a local population who have suffered a fragility fracture, with the aim of reducing their risk of
subsequent fractures.’’
A Fracture Liaison Service (FLS)• A proven model for fragility fracture prevention• All patients > 50 years who fracture are targeted• 50% of hip fracture patients have had a prior
fragility fracture• Where treatment is initiated, up to 50% hip
fractures could be avoided in future
• Clinically and cost effective
Find them
Assess them
Treat where appropriate Follow-up
Priorities and Plans for NOS in 2015Aim 1: Every person aged over 50 who breaks a bone is assessed for osteoporosis and managed appropriately.Priority 1:
Extend coverage of Fracture Liaison Services in the UK
Priority 2:Improve quality of Fracture Liaison Services and osteoporosis services
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FLS Mapping
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Some Hospitals/Areas already have
FLS Implementation• Engage with sites wanting to set-up FLS• Set up a stakeholder meeting• Establish patient/care pathway• Project manage/commissioning and funding• Assist with economic and business case• Service specification• Resource and capacity planning including staffing• Work with providers ensuring FLS is sustained• Data collection, analysis, reporting and evaluation• Ensure service meets FLS Clinical Standards
The impact of FLS is both clinically & cost effective
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UK FLS Clinical StandardsThe 5IQ approach describes the key objectives of an FLS:
• Identification
• Investigation
• Information
• Intervention
• Integration
• Quality www.nos.org.uk/fls
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Gap AnalysisGap Analysis establishes to what degree an existing service is ‘performing’ against the Standards• Informative• Detailed • Specific• Targeted• Constructive
Generic FLS Pathway
FALLS RISKASSESSMENT
NEW CLINICAL FRACTURE
NEW VERTEBRALFRACTURE
(RADIOLOGY REPORT)
PREVIOUS FRACTURE OR FRACTURE NOT PRESENTING
TO ACUTE CARE
ORTHO IP
Virtual/#CLINIC
‘CASE-FINDING’ BY FLS‘CASE-FINDING’ BY COTE
‘CASE-FINDING’ BY GP/SEC CARE/CH
FLS RISK ASSESSMENTONE-STOP CLINIC
WITH DXA
EXERCISECLASSES
Rx FOR FRACTURE 2Y PREVENTION
EDUCATIONPROGRAMME
CARE OF THE
ELDERLY
4 & 12 MONTH FOLLOW UP
CLINIC
COMPLEX CLINIC
(IF REQUIRED)
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Most hospital with/without FLS• Inpatient hips • Fracture clinic Challenges • Other inpatients (k-wiring and plates)*• Patients included who fall/fracture on other wards• Spinal fractures • Radiology – incidental spinal fractures*Who may be missed?• Patients attending ED no follow up i.e. clavicle, ribs
pubic rami.• Patients admitted for other reason and fracture
identified on an X-ray …….
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What is the Impact of FLS• Glasgow model• Glasgow assessed more than 50,000
fractures between 2000-2010• Hip fracture rates reduced by 7.3% vs 17%
increase in England• For every 1,000 patients• 18 fractures were prevented• 11 hips fractures
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What are the economic benefits?• Hip fractures alone have an estimated health
and social care cost of £2.3 billion/year
Benefits Calculator
(http://benefits.nos.org.uk)
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DGH 300,000, 50+ 105,000, 332 hip #’s
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What Investment is Required?• STAFF
• Consultant for complex patients/mentor/supervise service
• Nurse specialist • Clerical/admin
• Set up costs – FLS accommodation, IT, DXA scanner and other associated costs:• DXA scans/reporting• Other diagnostics – bloods urine• Drug costs
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Use the FLS Implementation Toolkit1. Promotes commissioning of effective high-quality
services that are integrated within a system-wide approach
2. Ensures services are in accord with the evidence base and able to demonstrate outcomes
3. Stimulates provision of services that are sustainable
4. Make implementation easier, cheaper and more effective for commissioners and providers.
Frac
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Pre
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Prac
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Tra
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Abstract deadline: 3 June 2016Early-bird registration deadline: 5 August 2016
www.nos.org.uk/conference
Thank you