The drive in contemporary medicine is improved utilisation of scarce resources and a faster turn around of patients, with patients seeking faster recovery from surgery. Delaying factors in discharge from hospital following total knee replacement surgery include the time taken to get active extension and a straight leg raise following surgery. A retrospective case matched study of 20 patients shows that reducing the length of incision into the quadriceps tendon, therefore sparing the quadriceps mechanism speeds the post operative recovery significantly. Reducing the average time to discharge from 9.6 days in the control group to 3.2 days in the quadriceps-sparing group. All but one patient had an ASA grade of 2 with no significant co-morbidity in either group. No patient in either group suffered a post-operative medical event precipitating a delayed discharge. The criteria for discharge were the same in both groups.

The 1995 Audit Commission report, “Setting the Record Straight- A study of hospital medical records,” criticised the poor standard of NHS record keeping. A retrospective audit of documentation of patients undergoing a closed manipulation of distal radius fractures (Colles type) in the Accident and Emergency department of the Queen Alexandra Hospital revealed that note keeping still needs to be improved. Only 15% of patients had adequate documentation.