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New best practice pathway for non-ambulatory fragility practice

16 May 2024

A new national pathway, outlining the best practical concepts for ensuring patients with non-ambulatory fragility fractures (broken bone caused by a fall from a standing height or less) have access to excellent and fair NHS care, has just been shared by Getting It Right First Time (GIRFT).

The GIRFT Non-Ambulatory Fragility Fracture (NAFF) Pathway, provides guidance for all stages of the patient journey – from presentation in secondary care, admission and initial care, ongoing ward care and discharge and follow-up which should be applied to all NAFF patients, regardless of where the injury is.

The NAFF pathway is a collaboration between 38 stakeholders (including the Royal College of Emergency Medicine) with geographic and cross-specialty representation, and aims to address those operational practicalities, offering universal concepts Trusts can adopt to work towards a more equitable service, using existing resources.
Mr Bob Handley, GIRFT’s clinical lead for orthopaedic trauma surgery, led the working group which developed the pathway.

He said: “During my GIRFT reviews I have seen that many units have rightly put considerable effort into improving their hip fracture pathways.

“The combination of the National Hip Fracture Database, national guidelines and Best Practice Tariff has created an environment for constructive change. Now it is important that units take steps to extend these benefits to all NAFFs to ensure equitable access to care for all fragility fracture patients.

“We are confident we have identified an approach which will foster the team management required – not based on significant new investment but on equitable and efficient use of currently available resources – with a key component being the Board responsibility to oversee and report on equitability.”

Dr James France, Chair of RCEM’s Quality in Emergency Care Committee, said: “RCEM was pleased to be able to contribute to the development of this pathway which prioritises a hospital multidisciplinary approach to those patients who are unable to be discharged from the Emergency Department after sustaining a fracture.”

* On Tuesday 21 May 2024, a GIRFT webinar will be held at 12:30pm to launch the new pathway. The session will include contributions from clinicians in emergency medicine, geriatric medicine and physiotherapy, plus the team from North Bristol NHS Trust, who are successfully managing their older injured patients under one agreed process as a cross-specialty team. Register for the GIRFT NAFF webinar here.

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