Innovative Electronic Fractured Neck of Femur Pathway launched

Electronic Fractured Neck of Femur Pathway (E-NOF) is a new tool designed to improve compliance with Best Practice of Care by standardising data recording in a paperless form.

Through its selection as a finalist for anaward at the BOA Congress 2017 in Liverpool (17 – 21st of September), E-NOF was presented as ‘Introduction of a paperless neck of femur pathway’. This was the opportunity to present the innovative system to the UK orthopaedics world and to launch it for wider adoption in the UK.

Nikhil NanavatiThe E-NOF project was initiated by a specialist registrar, trauma and orthopaedic surgery (Nikhil Nanavati, pictured) and a computer programmer (Richard Housham) at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTH). E-NOF represents a solution, ensuring that patient assessments are carried out in compliance with the standards of care. Via improved documentation, E-NOF can increase the number of patients taken along the pathway in a timely manner. Real time visualisation of the pathway ensures that all the steps are followed and that data can easily be checked and audited to identify the potential to improve Best Practice. In addition, data collected can be automatically fed into the National Hip Fracture Database (NHFD)format for submission. E-NOF improves patient care and increases the potential for best practice tariff.

The development of such a system comes in response to the National Hip Fracture Database report which highlights the huge variations in performance between hospitals: from 16.7% to 92.8% in the rate of surgery on the day or the day after admission, from 0% to 90% in the rate of orthogeriatric assessment before surgery. The report also highlighted poor compliance with best practice, with 18.7% failing to achieve best practice on ‘theatre within 36 hours’ due to administrative reasons in 50% of cases. This report published in 2016 was followed by the NHFD declaration that ‘Performance run charts will be made public, at which point poor data quality will have more serious implications for providers’.

Over the last 3 years, with the support of the IT department at DBTH, E-NOF was developed into a fully functional checklist-based software application which has been successfully implemented at the two hospitals sites – Doncaster and Bassetlaw. It is currently in routine use and forms part of the induction process of all new staff, including junior doctors, with the support of the orthopaedic team - consultants, advanced clinical practitioners and the nursing team.

As a Trust member of Medipex – NHS Innovations Hub in Yorkshire and Humber, the team received full assistance during the assessment of this project and its management, and with the approval of DBTH management (Innovations, IT and Finance), Medipex will lead the commercialisation phase of this software. The project team has started to identify opportunities for adoption of E-NOF by other hospital trusts and Illuminaries Ltd will be our IT partner in this commercial venture.

Through our presence at Liverpool BOA 2017 event, we have started to attract interest in E-NOF from orthopaedic professionals and initial signs show that there is appetite for this innovative electronic system that will help orthopaedic departments to standardise the collection of data and to move away from ‘archaic’ paper based processes.

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