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.

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Abstract deadline: 3 June 2016Early-bird registration deadline: 5 August 2016

www.nos.org.uk/conference

Thank you