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The Fracture Liaison Service Database (FLS-DB) Jan to December 2021FLS-DB 2021 organisational data

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OrgCode	FLS Name	Where is the FLS delivered from?	Which NHFD hospitals do you provide the FLS to?	What month and year did you start the current form of FLS?	How would you describe the current contract?	How many Consultant PAs (per week) are allocated to the FLS?	How much time is spent working within the FLS as the whole time equivalent?			Estimated population size	Which patient groups does your FLS cover? Hip fracture (including inpatient fractures)	What restrictions are there on the patients seen by your service?	What restrictions are there on the patients seen by your service? Other response	If fracture site is a restriction selected, please specify which fracture sites excluded	How does your site identify hip fracture patients?	How does your site identify hip fracture patients? Other response	How does your site identify other non-hip non-vertebral fracture inpatients?	How does your site identify other non-hip non-vertebral fracture inpatients? Other response	How does your site identify fracture outpatients?	How does your site identify fracture outpatients? Other response	How does your site identify patients with vertebral fracture(s)?	How does your site identify patients with vertebral fracture(s)? Other response	If applicable, what barriers have you experienced in finding patients with vertebral fractures?	If applicable, what barriers have you experienced in finding patients with vertebral fractures? Other response	Does your site have a process for identifying potentially eligible fragility fracture patients who should have but did not receive assessment for secondary fracture prevention?	Does your site have a process for identifying potentially eligible fragility fracture patients who should have but did not receive assessment for secondary fracture prevention? Please give details	What tests do you routinely use for identifying underlying secondary causes of osteoporosis?	Do you have access to DXA scan or do you use an alternative provider or tool?	Who assesses the need for treatment?	Who assesses the need for treatment? Other response	What interventions can be recommended or initiated by the FLS?	How do patients obtain their first prescription of bone sparing treatment, if it is recommended?	Do you routinely provide a falls assessment as part of your FLS?	Which of the following are covered by the falls risk assessment in the FLS?	If Assessment of gait, balance and mobility is selected in 6.2 which assessments are used?	If Assessment of gait, balance and mobility is selected in 6.2 which assessments are used? Other response	Who receives the report from your FLS that summarises the outcomes of assessing patient need for treatment to prevent secondary fractures?	What information is included in the report?	Who is responsible for monitoring patients seen in the FLS?	What does the re-evaluation include?	How is adherence assessed or re-evaluated?	How often is there a formal survey seeking patient/carer views on the FLS?	How many completed responses did you get from your FLS patient survey?	Did you use the ROS patient experience survey?	Do you use the FLS-DB patient resources?	Do you use the FLS-DB patient resources? (if no selected, please specify barriers to using them if any)	How often does your FLS have a minuted governance meeting?	Please list the reporting structures for the governance minutes	How are patients involved in the governance of the FLS?	How are patients involved in the governance of the FLS? Other response
ADD	Cambridge University Hospitals NHS Foundation Trust FLS	An acute hospital	ADD Addenbrooke's Hospital	Apr-17	Block payment	2	Nurse~band 6~3.6;Nurse~band 7~1	Yes	2 band6 9/12 vacancies	500000	Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Opportunistic radiological vertebral fractures	Age range;Fracture site	Not set	Scaphoid;Metacarpal;Metatarsal;Face/skull;Rib	Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems;Trauma lists	Not set	Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended	Not set	Using clinic lists;Other IT systems;Emergency Department lists;Referral from Emergency Department	Not set	Fracture clinic lists;Emergency Department lists;Other	Opportunistic case finding by orthogeriatricians / medical consultants	Still developing pathway;Other	Not set	Yes	Often identified in OPD TO clinic and FLS clinics	Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein)	DXA available on site	FLS specialist practitioner;Other	Cases discussed at FLS MDT with consultants	Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests	FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes	Yes	A formal assessment of cognition;Assessment of continence and toileting;Assessment of a history of falls;Number of falls in the last 12 months;Assessment for fear of falling;Review of all medications and combinations of medications that increase falls risk;Assessment of gait and balance and mobility;A requirement to check lying and standing BP;Pulse check for rhythm and rate;An evaluation of vision;Assessment of home hazards	Ask about gait problems	Not set	Patient;Primary care physician;Falls service	Date and type of fracture;Fracture risk score;DXA – BMD;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment	Specialist nurse;Delegated to Primary Care physician	Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other	Telephone interview	Never	Not set	No	Yes	Not set	1	Rheumatology governance	Patients are represented in the governance meetings	Not set
AHX	Ashford and St Peter's Hospitals NHS Foundation Trust	An acute hospital	SPH St Peter's Hospital	Nov-12	Block payment	0	Nurse~band 7~1	No	Not set	410000	Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures)	Age range;Fracture site	Not set	Scaphoid;Face/skull;Rib;Avulsion	Seen by Orthogeriatric service not FLS	Not set	Not applicable	Not set	FLS visits the orthopaedic/trauma clinic	Not set	Visits spine clinic/reviews letters;Fracture clinic lists	Not set	Still developing pathway	Not set	No	Not set	Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Serum Electrophoresis;Serum free light chains	DXA available on site	FLS specialist practitioner	Not set	Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests	FLS recommends therapy to orthogeriatrician and/or primary care physician	Yes	Number of falls in the last 12 months;Assessment for fear of falling	Not set	Not set	Patient;Primary care physician	Date and type of fracture;Fracture risk score;DXA – BMD;Current drug treatment recommendations (if applicable);Medication compliance review	Delegated to other healthcare provider	N/A monitoring is not carried out by the FLS	N/A monitoring is not carried out by the FLS	Never	Not set	No	Yes	Not set	0	No governance minutes	Patients are not involved in governance	Not set
BAT	Royal United Hospital	An acute hospital	BAT Royal United Hospital Bath	Aug-16	Block payment	0.3	Nurse~band 6~1;Nurse~band 7~0.6	No	Not set	500000	Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures	Age range;Fracture site	Not set	Metacarpal;Metatarsal;Face/skull	Seen by Orthogeriatric service not FLS;Fracture clinic lists;IT systems	Not set	Ward/emergency room admissions/discharge lists;Radiology;Seen by Orthogeriatric service;Other IT systems;Fracture clinic attended	Not set	Using clinic lists;Other IT systems;Emergency Department lists	Not set	DXA imaging (VFA);Screening general radiology reports;Fracture clinic lists;Emergency Department lists;Other	FLS tag included in radiology reports if vertebral fracture identified to allow for text search algo	Lack of standardised practise/language for radiology reporting;Other	Not all radiologists report FLS tag consistently	Yes	Coding send monthly inpatient lists who have had a fracture;Peripheral clinic referrals	Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Full blood count;Liver function;Thyroid function;Liver function tests;Renal function tests;Coeliac disease screen;Serum Electrophoresis;Urine electrophoresis (for Bence Jones protein);Serum free light chains;Testosterone/ Sex hormone binding globulin	DXA available on site	FLS specialist practitioner;Clinician speciality;Delegated to Primary Care physician	Not set	Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Teriparatide;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests	FLS recommends therapy to orthogeriatrician and/or primary care physician;Orthogeriatrician prescribes;Metabolic bone disease / osteoporosis specialist prescribes	No - we refer patients on for a falls assessment	Not set	Not set	Not set	Primary care physician;Service that referred to FLS	Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Follow-up plan;Lifestyle/health risk-factor assessment	FLS coordinator;Specialist nurse;Delegated to Primary Care physician	Medication adherence;Medication persistence;Medication adverse effects;Residential status;Recurrent fractures	Telephone interview;Postal questionnaire	at least every 3 years	50	Yes	Yes	Not set	1	trust audit;Rheumatology governance	Patients are not involved in governance	Not set
BED	Bedford Hospital	An acute hospital	BED Bedford Hospital	Apr-18	Fixed term then need to renew	1	Nurse~band 7~1;Administrator~band 3~0.2	Yes	band7, 6months	387947	Hip fracture (including inpatient fractures);Non-hip inpatient fragility fracture on orthopaedic/trauma wards;Non-hip inpatient fractures on non-orthopaedic/trauma ward (including inpatient fractures);Orthopaedic/trauma fracture outpatient clinics (e.g. wrist fractures);Presenting with a clinical vertebral fracture;Vertebral Fracture Assessment using DXA spine imaging;Opportunistic radiological vertebral fractures	Age range;Fracture site;Other	50 Plus	Ankle;Metacarpal;Metatarsal;Face/skull;Rib;Patella;Avulsion	NHFD lists;FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions lists;Seen by Orthogeriatric service not FLS;Fracture clinic lists;Trauma lists	Not set	FLS visits the orthopaedic/trauma ward;Ward/emergency room admissions/discharge lists;Seen by Orthogeriatric service;Fracture clinic attended	Not set	FLS visits the orthopaedic/trauma clinic;Using clinic lists;Emergency Department lists;Other	X-ray department	Screening general radiology reports;Re-reading radiology images;Fracture clinic lists;Emergency Department lists	Not set	Unable to access radiology images;Other	Sometimes a lack of specification of exact place of vertebral fracture on the report	No	Not set	Serum Calcium;Serum phosphate;Serum alkaline phosphate;Serum 25OH vitamin D;Serum Parathyroid hormone;Liver function;Thyroid function;Liver function tests;Renal function tests	DXA available on site	FLS specialist practitioner;Clinician speciality	Not set	Written material;Calcium and vitamin D supplementation advice;Oral bisphosphonates;Denosumab;Intravenous bisphosphonates;Further education programmes/resources;Clinic follow-up by appropriate specialist if abnormalities are identified on blood tests	FLS recommends therapy to orthogeriatrician and/or primary care physician	No - we refer patients on for a falls assessment	Not set	Not set	Not set	Patient;Primary care physician;Orthopaedic surgeon or clinician responsible for fracture care;Falls service;Service that referred to FLS	Date and type of fracture;Fracture risk score;DXA – BMD;DXA – vertebral fracture assessment or spine X-ray result if done instead;Primary osteoporosis risk factors;Secondary causes of osteoporosis (if applicable);Fall risk factors;Current drug treatment recommendations (if applicable);Medication compliance review;Follow-up plan;Lifestyle/health risk-factor assessment;Other	Specialist nurse	Medication adherence;Medication persistence;Medication adverse effects;Residential status;Post fracture mobility;Started a programme of strength and balance exercise;Recurrent fractures;Recurrent falls;Other	Telephone interview;DXA	Never	Not set	No	Yes	Not set	2	CCG Quality Lead Governance;Escalate any issues for concern through the Commissioning directorate	Patients are not involved in governance	Not set