NHS FIFE ORTHOPAEDIC UPDATE Mr Edward Dunstan Orthopaedic Clinical Lead May 2015

Enhanced Recovery

Results – Cumulitive Discharge Rates

Factors affecting LoS Predictors in Model B Value95% CIp-value ERP to -1.6<0.001 Catheter to -1.3<0.001 Age to 0.07<0.001 ASA1Reference to 0.75< to 1.50< to 2.25<0.001 Approach Anterolater al Reference Posterior to <0.001 Preoperative HHS to <0.001

RAPT (Risk Assessment and Predication Tool) Age Gender Mobility Walking Aids Community Support Lives alone Identify those who require extended rehabilitation at time of listing

RAPT 42 consecutive patients 20 with a score >/= 9 18 home within 4 days 16 of the 18 with a score 6-8 home > 4 days What to do with those with a score <9 ? Rehabilitation facility ? Community based rehabilitation team

Fracture Neck of Femur

Theatre Optimization

?SCAPHOID !!!!!!!!!!!!!!!!!

NHS Fife Orthopaedic Service Improvements Enhanced Recovery for Hip and Knee Arthroplasty Reduced length of stay - 4 Days Redesign Pathway to Support QOF Guidance for Knees Spinal Clinics New Clinics at WMB and QMH Increased Capacity 32 Patients Defined Fife Pathway Intranet Advice and Guidance 90% Patient Satisfaction with Clinics Redesign Low Back Pain Pathway Orthopaedic Advice and Guidance NHS Fife Orthopaedic Guidance ? Desk Top Help Tool ? Referral Advice Fields Increased Compliance with SIGN Guidelines Vetting Times Reduced from 10 to 2 Days Referral Management Enhanced Communication Reduces Patient Anxiety Reduces Patient Pathway by 8 weeks GP Direct Access to MRI (Radicular Pain) Advice via Referral Management System E-advice Maximisation of Workforce Management Consistency Reduced Patient ‘Hand-Offs’ Increased capacity by 40 patients a month GPwSI Community Knee Clinic Transfer of Physiotherapy Staff to Primary Care GP Orthopaedic Training Delivered Physiotherapy Services Shift in Balance of Care Primary Care Diagnostics Redesign Reduces Risk of Chronicity Virtual Advice Clinics Integrated Service Physiotherapy Community Spinal Clinic Multidisciplinary Diagnostic Group Exploring Expansion of Access Patient Involvement Patient Support and Input New Service User Information Leaflets User Involvement and Patient-Centred Ongoing Research

Neck Lumbar Shoulder Hip Thoracic Elbow WristHand Knee AnkleFoot  Cauda Equina  Acute trauma/fracture Refer to A&E  Suspected Malignancy  Infection  Progressive neurology Refer to Secondary Care Acute Soft Tissue Injury Service User Information Healthy Working Lives Adviceline on Fife Sport and Leisure NHS Fife Musculoskeletal Resource Tool NHS Inform Musculoskeletal National Advice NHS Fife Summary Orthopaedic Referral Guidelines Useful Links Analgesic Ladder Musculoskeletal Medication Advice Physiotherapy Referral Guidance NHS Fife Orthopaedic Pathway Hover over area and ‘click’ for further advice Terms of Use Minimum Information Required for Orthopaedic Referrals NHS Inform Info Sheet Chronic Pain 20