Implementation Strategies

Scientific evidence shows that a coordinated, multi-disciplinary approach to patient care is the most clinically and cost-effective in preventing secondary fractures. A systematic approach to secondary fracture prevention can result in fewer fractures and significant cost savings to healthcare systems. The IOF Working group has published an important review outlining the evidence.

The key steps in implementation described in the review are:

Get the idea onto the provider’s agenda

  • Conduct a baseline audit to confirm the care gap

Create a service development team, headed by a champion, which is likely to include:

  • Lead clinician/local champion
  • Secondary care clinicians – consultant orthopaedic surgeon, consultant radiologist, consultant geriatrician
  • Nurse specialists/practitioners (if and when appointed)
  • Local primary care providers
  • Patient representatives
  • Allied health professionals e.g. physiotherapists
  • Consultants in Public Health
  • Service/business managers for institution/locality
  • Community-based pharmacists
  • Hospital/local community prescribing management team member

Secure access to post-fracture patients

Estimate the workload and resources needed

Define the role of the post-fracture coordinator

Engage with the local planning machinery

Start prospective data collection

Initiate the service and develop it iteratively

Rapid cycle process improvement methods have been central to the development of successful coordinator-based, post-fracture models of care throughout the world. This method applies sequential Plan-Do-Study-Act (PDSA) cycles, details of which are available in a publication from the United States:

More comprehensive information pertaining to implementation of coordinator-based, post-fracture systems of care is available from the National Toolkits, Policies and Guidelines section of this website.