Orthopaedics at Dorset County Hospital…Why choose us? Iain Findlay Consultant Knee and Hip Surgeon GP Refresher Week November 2016

GP Refresher Week November 2016 Our Challenges Ageing Population Increased referral rate (6.5%) Competitive market Increasing BMI DCHFT operating on higher ASA grade patients Bed Pressures It is going to be a busy time. 6.5% increase in referrals 2014/2015. Ageing population (an average of the population is now 40 years old!). Dorset has highest % popn over 65% in UK. 92% increase in number of revision TKAs over last 5 years. Higher ASA grade (? Low ASA Choose and Book away), high BMI. Higher demand younger patients with both soft tissue injuries and the incredibly difficult problem of knee OA <60 yrs old. “Getting it right first time” paper => arthroplasty on a pedestal. Revision Arthroplasty Surgery “Getting it right first time” report Social Demographics of Dorset GP Refresher Week November 2016

The Potential Solutions Continue to provide an efficient, cost effective orthopaedic service. Maintain ownership of our patients. Clinical Governance with auditing of our results. Improve patients’ outcomes. Improve patients’ experience. Only £2000 savings identified in £17 million turnover Carter Report 2017 GP Refresher Week November 2016

Primary Knee Arthroplasty Referrals Out-patient Clinics Pre-assessment +/- Anaesthetic review & Prehabilitation Operation In-patient stay & Enhanced Recovery Follow-up & PROMs data Not reinventing the wheel, just optimising our service…lean manufacturing. Waiting list from referral to operation, adapt to fluctuations. 18 weeks. Pre-assessment – risk stratification. Wait for Echo. PROMs data, maintain our high standards, look at pre-op OKS, monitor our improvements. Cost-effective service – AllPoly tibias (saving £200 per case). Efficient discharge and early follow-up (? Orthopaedic Nurse Practitioners). Publicise this to GPs!!! GP Refresher Week November 2016

Prehabiliation Clinic & Optimisation Clinic Lead by Consultant Anaesthetist - Dr S Baker. Aim differs from pre-assessment. Not “are you fit for surgery” but “are you as fit as possible” for surgery. Screening questionnaires & fitness assessments!!! GP Refresher Week November 2016

Enhanced Recovery Programme All patients are provided with a comprehensive information booklet that takes them through their joint replacement pathway. Patients in the Weymouth, Dorchester and Portland areas are invited to attend a hip/knee education class. Improved patient experience has been evidenced in several ways… Friends and Family Feedback. PROMs. Referrals. GP Refresher Week November 2016

Dorset County Hospital Patient Ownership If you have concerns regarding a post operative THR or TKR wounds call Ridgeway ward 01305 255561/62 and ask for the nurse in charge. We will arrange for the patient to be seen on the same day by either a Registrar or Consultant. Please share this information with your colleagues . GP Refresher Week November 2016

Dorset County Hospital Patient Ownership GP Refresher Week November 2016

What we can do to improve Waiting list times. “Lean manufacturing” – a cost-effective, efficient service. Reviewing patients with concerns or problems. Feedback with yourselves, between ourselves and with MSK. The aggregation of marginal gains! GP Refresher Week November 2016

GP Refresher Week November 2016 Any questions? GP Refresher Week November 2016