The workstrands within trauma and orthopaedics MSK are:
AHP MSK redesign : getting patients on the right pathway
Fracture pathway redesign : patients only attend fracture clinics if there is a clinical need
Enhanced recovery : optimising patient recovery after joint replacement
Hip fracture care pathway : optimising care of frail older people
Demand and capacity planning and management : supporting strategic and operational decisions
What is achievable?
What will success look like?
A consistent best practice pathway is the norm for all patients in Scotland. Each hospital has a local consensus on the clinical interventions along the pathway that should apply to all joint replacement patients (and where variation from the standard protocol is clinically appropriate that the degree of variation is agreed and followed by all).
Five days or less is the norm for post-operative length of stay (already achieved for at least 80% of hip and knee replacement patients by the top quartile of hospitals in the MSK Audit - summer 2013).
No outlier hospitals for: Readmissions within 28 days; Wound Infections; Dislocations; and, VTEs (data from ISD - SMR, SSI and Scottish Arthroplasty Project).
Each Orthopaedic Department has a continuous improvement process including testing small cycles of change and measurement of key indicators.
What is the potential impact?
An improved patient experience with faster recovery. This will be encouraged by reductions in the rates of nausea and vomiting, catheterisation, blood transfusion, post-op IV fluid requirement and VTE complications, accompanied by optimised pain management, early return to normal diet and early mobilisation - Good quality care costs less than sub-optimal care.
If the lower three quartiles of hospitals achieved the same level of Post-op LOS as the top quartile for hip and knee replacement patients this would free-up a further 12,000 bed-days p.a. (21%). This is one of the key enablers for greater throughput of patients and therefore less need for use of non-core capacity.