E-NOF Electronic Fractured Neck of Femur Pathway

The Compliance Solution

Can you demonstrate that you are compliant?

According to the 2016 NHFD report from the 177 NHS hospitals currently submitting data to the NHFD:

  • The rate of orthogeriatric assessment before surgery is over 50%, with variation for individual units from 0% to nearly 90% of patients
  • Huge variations in performance between hospitals with figures ranging from 16.7% to 92.8% in the rate of patients undergoing surgery on the day of or the day after admission.
  • In England, 18.7% of patients fail to achieve best practice care on ‘theatre within 36 hours’ alone. 50% of patients are delayed for administrative reasons
  • 20% of hospital lead clinicians do not carry out any quality checks of data submitted to NHFD
  • BPT achievement rates were around 63% in 2016

The 2016 NHFD report indicates that: ‘Performance run charts will be made public, at which point poor data quality will have more serious implications for providers.’

The Problem

The recording of fractured neck of femur pathway data is traditionally based on a paper checklist in NHS departments. The practice of surgical clerking is different in each Trust and even between departments within a Trust, as some staff will use the paper form and some will not. As this information is recorded in a non-standardised manner by staff, this leads to inaccurate recording of tests undertaken and administrative errors, compounded by limited clinical lead management of the pathway. These factors limit potential improvements in patients’ care, in meeting British Orthopaedic Association Best Practice standards of care and in increasing opportunities to benefit from Best Practice Tariff. This is despite wide acknowledgement that in addition to being detrimental to patient experience, delays to operations have clear links to increased mortality and that key early indication of patient outcomes is time from admission to operation.

This led an orthopaedic clinician and an IT developer from Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust to develop a new tool E-NOF to standardise care.

The Solution

A new tool designed to improve compliance with Best Practice of Care by standardising data recording in a paperless form, allowing real time pathway and patient care monitoring, whilst increasing the potential for Best Practice Tariff.

The introduction of the Electronic Fractured Neck of Femur (E-NOF) tool is destined to ensure that patient assessments are carried out in compliance with the standards of care along the pathway: from admission through to discharge. Via improved documentation of patient assessments, the tool can increase the number of patients taken along the pathway in a timely manner. Using real-time visualisation of the pathway, E-NOF ensures that all steps are followed, that patients can be prioritised, and that data can easily be checked and audited to identify the potential to improve Best Practice. E-NOF provides Trusts with the potential to improve patients’ care, in terms of better pre-operative optimization and preventing delays to theatre, thereby reducing morbidity or mortality. It can also improve eligibility for Best Practice Tariff. Furthermore, data collected can automatically be fed into NHFD format.


  • Allows clerking information on patient assessment at each stage of the pathway
  • Ensures that every step of the patient assessment is carried out via prompts
  • Appropriately prescribes tests (e.g. blood, AMTs) and captures results
  • Tracks patients on the pathway with ability to prioritise
  • Ensures that the patient is moved along the pathway in a timely manner, via alerts
  • Visualises performance in accordance with time targets
  • Records name and signature of staff undertaking tasks
  • Makes sure that all staff are appropriately and accurately contributing to clerking

The Benefits

  • Real time pathway monitoring
  • Increasing compliance and patients’ safety via appropriate clerking of patients’ assessment
  • Standardisation of good practice via timely monitoring (4h to ward admission, 36h to theatre, 72h perioperative assessment)
  • Easy access to patient pathway data in one single shared form via internal IT system
  • Simple, quick and easy to use – an intuitive checklist form for clerking, checks, sign offs and audits
  • Improves accuracy of data recorded (as opposed to handwritten notes)
  • In accordance with NHS England aim of a ‘Paperless NHS by 2020’
  • Standard suitable format for NHFD automatic submission
  • Suitable for use with desktops, tablets & mobile phones (bedside use)
  • Adopted by Doncaster and Bassetlaw NHS Foundation Trust Hospitals

 Technical features

The technology stack and code base used to develop the E-NOF system consists of:

  • Web Application – Microsoft ASP.NET MVC 5 with .NET framework 4.5.2 running under IIS on a Microsoft Windows 2008 R2 Server (or later
  • Database – Microsoft SQL Server 2008 (or later)
  • HL7 Integration Engine – Mirth Connect

The deliverable product will be populated at each end user site with appropriate site specific information needed for each customer's requirements by the Configuration Tools but it is not anticipated that any customisation of the core product will be required or offered.

Contact Us

For an informal chat, please contact Mr Stephen Taylor-Parker, by phone: 0113 3970 830 or email: stp@medipex.co.uk.

Or to request access to an online demo, please click here - E-NOF Demo.