The SIMPLER nutrition pathway for fragility fractures: A quality improvement initiative

Bell, Jack J., Geirsdottir, Olof Gudny, Johansen, Antony, Santy-Tomlinson, Julie, Frihagen, Frede, McGlasson, Rhona, Sutton, Emma and Hertz, Karen 2025. The SIMPLER nutrition pathway for fragility fractures: A quality improvement initiative. Nutrients 17 (12) , 1987. 10.3390/nu17121987

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Abstract

Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018–2025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the “know-do” gap, and adapted SIMPLER to context through iterative action–reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n = 308, 46 countries), two bi-national audits (n = 965, 63 hospitals), and qualitative interviews (n = 15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action–reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to the local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusions: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support the delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: https://creativecommons.org/licenses/by/4.0/, Start Date: 2025-06-12
Publisher:	MDPI
Date of First Compliant Deposit:	27 June 2025
Date of Acceptance:	5 June 2025
Last Modified:	27 Jun 2025 07:45
URI:	https://orca.cardiff.ac.uk/id/eprint/179350

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