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

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

• MK Javaid
• Norman Collisson Lecturer in Metabolic Bone
  Disease, University of Oxford
• Hon Consultant Rheumatologist, Nuffield
  Orthopaedic Centre
• Lead Clinician for FRiSCy

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Regional status How big is the problem?
4260 hip fractures 12,800 non-hip fragility
fractures
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Fracture Reduction in South Central PolicY group

• AIM
• Every patient with a fragility fracture
• over the age of 50yr in South Central is
• Identified
• Assessed
• Treated effectively for at least five years
• for both bone and falls health

A network of every bone clinician/ Nurse
Fracture Liaison Service gt Fracture Prevention
Service
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Finding them all
Complete assessment
See patient while in trauma
Re-fracture reduction
Start Monitoring
Commitment to ongoing Patient support
Critical First Impression Face to face
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UNDER 75 years
DXA
Falls Generations Game
Care Home
Assess Treat
Dementia
Renal Care
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2,481 patient assessed 1,257 referred for DXA 545
monitored
x0.5 Band7, x3 Band6 (1 maternity leave),
x1.5Band4
Oxford FPS 11 2011 -11 2012
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Information streams
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Datahub assist
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Elfin

• electronic
• fracture
• prevention
• patient support programme

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Data input once
OUTPUT
INPUT
DATABASE
Assessment
Effective nurse use

• Output many times

GP letter
Referrals Requests
Audit reporting
Patient information
Patient recall
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• Active Systematic Monitoring

NON Adherence
NON response/ re-fracture
Patient Safety
Adverse events
Therapeutic Tailoring
Effective fracture reduction
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Patient Information Prescription
Patient Experience
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Interfaces
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• Product
• Features
• Standards
• Systems
• Performance

Milestones

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

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Stakeholders
Clinician
Specialist nurse/ Administrator
NHS IT and Data protection
Patient and 3rd Sector
Commissioner/ reporting
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1. Data dictionary complete
2. Data entry forms 3rd round beta testing
3. Output to GP and patient letter 2nd round of
   beta testing
4. Export completed basic, next anonymised
5. Linkage to patient registration, appointments and
   labs in progress in Oxford
6. Scheduling completed
7. Platforms memory stick, laptop, server,
   integrated
8. Written in xml
9. Open source no licence or user fees
10. Phase I sites selected and programmer found

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PHASE I
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PHASE II
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PHASE III
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PHASE IV
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PHASE V
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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

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Evaluation

• User usage
• Reduced in NHS administration costs
• Audit
• Research

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Questions?