Label Info
0.00 N/A  
1.00 Symptom  
1.10 Symptom Description  
1.20 Incidence & Prevalence  
1.30 Prevention of index fall or fracture   RCP audit shows number of fractures per year
1.60 Escalation thresholds  
1.70 Red Flags  
2.00 Initial assessment of patients hip # & general Ax  

Full clinical examination determines if pts priority is medical or orthopaedic 

Including ambulance services - provision of care & community system of alerting primary care
2.10 Dx thresholds  
2.20 Assessments (Ax) & Diagnostics (Dx)  

2.2.1 Hip x-ray confirms / excludes fracture

2.2.2 Infection treatment eg UTI, Pneumonia
2.30 Decision aids   If not fit only delay if poss to optimize fitness with medical Tx  or conservative Mx
2.40 General Treatments (Tx)   2.4.1 EDD (expected discharge date) where possible. Identify any home or carer issues to be resolved
2.60 Transfer to ward or theatre   BOAST 3 Hip # pts require nursing, orthogeriatric, medicine & surgical expertise
2.70 Red Flags   If x-ray shows no # then exit to seconday falls & fractures prevention pathway
3.00 Peri-operative (inc full pre-op assessment)  

Anaesthetic Ax - review of fitness for surgery & decision on type of anaesthetic eg GA / Spinal

Surgical Ax - review of operation planned

3.10 Dx thresholds & decision aids  
3.20 Assessments (Ax) & Diagnostics (Dx)  
3.30 Decision aids  
3.40 Definitive Treatments (Tx)  

3.4.2 Avoid cancellation for administrative reasons eg elective targets / list space. Bone biopsy if pathological # or past history of malignancy

3.4.4 Ongoing adequate analgesia inc nerve block where necessary & regular pain Ax

Thromboprophylaxis against DVT

Mx of immediate post op problems eg anaemia, infection
3.50 End of Life Care  
3.60 Review predicted rehab outcomes & length of stay by day 3 post op  
4.00 Post-op care  
4.10 Dx thresholds & decision aids  
4.20 Assessments (Ax)  

4.2.1 For complications related to surgery eg problems with fixation, wound infection, infected prosthesis & inc post op x-ray

4.2.2 Fracture due to bone fragility or pathological fracture eg from malignancy, myeloma etc - may inc blood tests & imaging

4.2.3  Include structured documentation of rehab progress and goals - Blue book , NHS Institute Focus on fractured neck of femur
4.30 Decision aids  
4.40 Definitive Treatments (Tx)  

4.4.4 Commence Tx for secondary prevention of fracture where indicated eg  Bisphosphonates, Calcium, Vit D, , Strongtium. If other cause of pathological fracture eg Paget's, Myeloma, malignancy may need specialist treatment - see tier 3 of secondary prevention pathway. NB in addition to rehab & discharge planning

4.50 Discharge - inc Rehabilitation, Review & QoL measurement  

Secondary prevention of falls & fractures requires ongoing bone health Tx see 4.4.4 & monitoring & prescribing from primary care. Falls prevention & maintain safety - refer to secondary falls prevention pathway. Potential to reduce acute hospital spell by adequate capacity in community rehab models. In Autumn 2009 PBR quality metrics & sequin data available

 
5.00