Introduction: Approximately 1000 FNOFs are treated in Northern Sydney Health Service (NSAHS) hospitals each year. Although the incidence of FNOF does not appear to be increasing in NSAHS, numbers are. FNOF is a condition with the potential for streamlining inpatient and rehabilitation services. NSAHS was successful in gaining funding for two years under the N.S.W. Health Department's Health Outcomes Programme Grants scheme.

Objective: To develop best practice guidelines for the prevention, treatment and rehabilitation of FNOF. Implement and monitor a best practice critical care pathway for FNOF treatment and rehabilitation.

Methods: Using Cochrane Collaboration systematic review methods, 7 volunteer reviewers undertook a systematic review of English language RCTs and meta-analyses using Medline and key source journals during 1995. A draft report outlining the results of both the review and a retrospective audit of current practice, was circulated to NSAHS orthopaedic nursing, surgical staff and allied health professionals for comment. The guidelines were then incorporated into a critical care pathway for the treatment and rehabilitation phases of FNOF in two NSAHS hospitals. The adoption and maintenance of the guidelines was monitored via a prospective audit.

Results: Key areas of service provision requiring change were identified by the systematic review and retrospective audit. Several strategies were employed to raise awareness and promote adoption of the best practice guidelines. This paper will present a case study of the project, highlighting successes and failures in strengthening the link between evidence, policy and practice in health care.