Elfin project- improving patient safety, experience and outcomes for secondary fracture prevention- an update

MK JavaidNorman Collisson Lecturer in Metabolic Bone Disease, University of OxfordHon Consultant Rheumatologist, Nuffield Orthopaedic CentreLead Clinician for FRiSCy

400

500 560

610

175360

600380

160

140

375

4260 hip fractures

~12,800 non-hip fragility fractures

Regional status: How big is the problem?

AIM:

Every patient with a fragility fracture

over the age of 50yr in South Central is: 1.Identified

2.Assessed

3.Treated effectively for at least five years

for both bone and falls health

Anetworkof everybone clinician/Nurse

Fracture Reduction in South Central PolicY group

Fracture Liaison Service > Fracture Prevention Service

Finding them all…

See patient while in trauma

Start Monitoring

Critical FirstImpressionFace to face

Complete assessment

Commitment to ongoing Patient support

Re-fracturereduction

Hip fracture ward patient

Wrist fracture clinic patient

Pelvic fracture Medical patient

Spine fractureGeneral patient

UNDER 75 years

DXA

Assess & Treat

OVER 75 years

Assess & Treat

Recommend to Patient and GP

Monitor for 5 years

Falls &GenerationsGame

CareHome

RenalCare

Dementia

2,481 patient assessed1,257 referred for DXA545 monitored

Oxford FPS 11 2011 -11 2012 x0.5 Band7, x3 Band6 (+1 maternity leave), x1.5Band4

Information streams

Datahub assist

Elfin

electronic fracture prevention patient support programme

Data input once

Output many times

GP letter

Patient informationReferrals &RequestsAudit &

reporting

Patient recall

DATABASE OUTPUTINPUTAssessment

Letter to GP

Letter to Patient

Effectivenurse use

Active Systematic Monitoring:

NON response/ re-fractureAdverse events

NON Adherence

TherapeuticTailoring

Effective fracture reduction

Patient Safety

Patient Information Prescription: Patient Experience

Interfaces

Product•Features•Standards•Systems•Performance

Milestones

1. Scoping exercise to develop product features, milestones and costs2. To develop, test and implement in Oxfordshire3. To implement in South Central hospitals 4. To engage extra-regional stakeholders for implementation

Clinician

Specialist nurse/ Administrator

NHS IT and Data protection

Patient and 3rd Sector Commissioner/ reporting

Stakeholders:

a. Data dictionary – completeb. Data entry forms –3rd round beta testingc. Output to GP and patient letter – 2nd round of beta testingd. Export – completed basic, next anonymisede. Linkage to patient registration, appointments and labs – in

progress in Oxfordf. Scheduling – completedg. Platforms – memory stick, laptop, server, integratedh. Written in xmli. Open source no licence or user feesj. Phase I sites selected and programmer found

PHASE I

PHASE II

PHASE III

PHASE IV

PHASE V

Next phase

• Complete beta testing in Oxford

• Extend throughout S Central phase II - IV

• Link with National Osteoporosis Society

• National and international availability phase V

Evaluation

• User usage

• Reduced in NHS administration costs

• Audit

• Research

Questions?