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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Dorset County Hospital Patient Ownership
If you have concerns regarding a post operative THR or TKR wounds call Ridgeway ward /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

8. Dorset County Hospital Patient Ownership
GP Refresher Week November 2016

9. 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

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