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Delivering a quality-assured fracture liaison service in a UK teaching hospital—is it achievable?

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Abstract

Summary

To determine whether new national guidance on the specifications of a fracture liaison service are realistically deliverable, 1 year of data on the performance of such a service were audited. Audit targets were mostly met. This audit demonstrates that these standards are deliverable in a real world setting.

Introduction

UK service specifications for a fracture liaison service (FLS) have been produced (National Osteoporosis Society, NOS) to promote effective commissioning and delivery of the highest quality care to patients with fragility fractures. How deliverable these standards are has not as yet been methodically reported. Our FLS was modelled on the ten NOS standards; performance was audited after 1 year to determine whether these standards could be delivered and to describe the lessons learnt.

Methods

Performance was audited against the NOS FLS Service Standards, with management based on the Fracture Risk Assessment Tool (FRAX®), the four-item Falls Risk Assessment Tool (FRAT), National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Groups (NOGG) guidance. Data were recorded prospectively on a database. The FLS commenced in May 2014, was fully operational in August 2014 and data were captured from 1 September 2014 to 1 September 2015.

Results

The FLS detected 1773 patients and standards were largely achieved. Most, 94 %, patients were seen within 6 weeks, 533 DXA requests were generated, 804 outpatient FRAT assessments were recorded (134 required falls intervention) and 773 patients had bone treatments started. On follow-up at 3 months, between 78–79 % were still taking medication.

Conclusions

Preliminary evaluation of a FLS implemented according to UK NOS standards demonstrates that the model is practical to apply to a large teaching hospital population. Collection and review of outcome and cost effectiveness data is required to determine the performance of this model in comparison with existing models.

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Acknowledgments

The authors would like to thank the members of the FLS for their hard work, excellent data keeping and assistance with any enquiries regarding the audit. The authors would also like to thank Chris Boivin and the DXA department for all their hard work in both providing the service and data for the audit.

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Authors and Affiliations

  1. Department of Clinical Chemistry, University Hospitals Birmingham, Birmingham, B15 2TH, UK

    K. E. Shipman

  2. Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    J. Stammers

  3. Falls and Fracture Prevention Service, University Hospitals Birmingham, Birmingham, UK

    A. Doyle

  4. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners & Department of Endocrinology, Queen Elizabeth Hospital, 3rd Floor Heritage Building, Birmingham, UK

    N. Gittoes

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  1. K. E. Shipman
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  2. J. Stammers
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  4. N. Gittoes
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Corresponding author

Correspondence to K. E. Shipman.

Ethics declarations

Ethical standards in regards to audit and data protection were adhered to.

Conflicts of interest

NG chaired the NOS Service Standards document and is a Trustee of the NOS and Chair of the Clinical and Scientific Committee of the NOS.

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Shipman, K.E., Stammers, J., Doyle, A. et al. Delivering a quality-assured fracture liaison service in a UK teaching hospital—is it achievable?. Osteoporos Int 27, 3049–3056 (2016). https://doi.org/10.1007/s00198-016-3639-y

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