- Assessed at triage as suspected NOF
- ED team leader notified
- Inclusion criteria
- Patient aged 70 years or older
- Hip pain post fall
- Suspected fracture neck of femur
- Exclusion criteria
- Patients meeting PACE criteria
- Multisystem injury
- Fall resulting from syncope
- Behavioural issues requiring hi level supervision
- ED workup:
- vital signs
- primary & secondary survey
- pathology & radiology as per STOP
- clerk patient’s history, examination and investigation results
- Once NOF confirmed – team leader to ring 2222 and request “NOF page”
- Orthopaedics reg & geriatrics reg receive page (also physiotherapist in business hours)
- Pt admitted orthopaedics (AMO 1) and geriatrics (AMO 2)
- Can be transferred to the ward without ortho/geri review in ED
- Preliminary management plan
- NBM, analgesia, regular meds, fluids
- IDC for all women (consider in men)
- Fascia iliaca block for pain management (see guide here)
- After hours admissions:
- Notify orthopaedic reg and on-call geriatrician directly at 0700
NB – Patients with no abnormal findings on x-ray but who are unable to mobilise or have ongoing pain should have a low threshold for CT imaging.