With an ageing population and increasing pressures on all orthopaedic services, it is vital that we are able to develop efficient and acceptable means to streamline the patient journey. Our department uses telephone review appointments for selected patients to reduce the need for additional visits to the outpatient clinic. The aim of this study was to assess the efficacy of this approach, and to determine whether it was acceptable to patients. We identified all patients who had received a first-time telephone review appointment within a four month period. Using a short structured telephone questionnaire they were asked about their experiences of the process, whether they had subsequently required a clinic visit, and whether they would have preferred to be seen in person in the clinic. 50 of the 55 (91%) patients were successfully contacted, and all gave consent to participate. Reasons for follow-up included post-operative discectomy and lumbar decompression, post-nerve root injection, and MRI results. All patients (100%) were satisfied with the telephone consultation. Only 8 (16%) would have preferred a clinic appointment with 5 of these subsequently visiting the clinic. 32 (64%) of the patients did not require a further clinic appointment for the same problem. 32 (64%) of patients stated that they were very satisfied with the overall follow-up process with the remaining 18 (36%) being satisfied. Our study has shown that using telephone review follow-up for selected patients is effective at reducing the number of clinic visits, and is acceptable to patients.
Theatre efficiency is an increasingly important factor as the health service is faced with an ever greater number of patients, but tighter fiscal restrictions. We carried out an audit was to utilise data collected routinely on the Opera Surgical Management System (CHCA, Canada) to look at the efficiency of orthopaedic theatre usage, and to look for potential areas of improvement. The data related to all elective procedures carried out by a single Orthopaedic Consultant in a city hospital, over a one year period. We found that lists frequently started late, with the first patient of the day entering the anaesthetic room after 9 am on over 50% of occasions. The reasons for this were not regularly recorded. There was a wide variability in the length of time taken to anaesthetise and position the patients. Although there was a weak association with the underlying health of the patients (ASA score), the seniority of the anaesthetist was not available for correlation. The turnaround time between cases was variable, with a tendency for it to take longer over the lunchtime hours. Almost a third of lists finished before 4.30 pm, mainly due to patient cancellations, however nearly a third of lists finished after 5.30 pm. We found that data routinely collected on our theatre management system provides useful information that could potentially be used to fine-tune our peri-operative processes, however greater detail about specific timings and delays affecting the patient journey would be required before any recommendations could be made to improve theatre efficiency.
The benefits of surgical treatments for osteoarthritis (OA) of the knee are well established. There are also advances in non-surgical management techniques that can be used successfully, and these may be particularly suitable for patients with mild to moderate disease, or for those in whom surgery is contra-indicated. Intra-articular viscosupplementation is one such method, and studies have shown that this can give short-term symptomatic relief. Our study looked at the patient perceived benefits of a course of Hylan G-F 20 (Synvisc¯) by comparing the modified Brief Pain Inventory short form (BPI-sf) scores before treatment and after three months. The BPI-sf is a validated, widely used, self-administered questionnaire that measures both sensory and reactive dimensions of the pain using scales of 0-10 or 0-100%. This study included 12 consecutive patients with OA of the knee treated with a course of three Synvisc¯ injections performed a week apart. The data were treated as non-parametric and therefore Wilcoxon signed rank tests were performed. The data are presented as median (IQR). The results showed statistically significant (p<0.05), and clinically significant (reduction >1 point) improvements in worst, best, and average pain scores (over the previous 24 hours) three months following treatment compared to those before treatment. Relief obtained from routinely taken analgesia was significantly improved from 30%(12.5-57.5) to 75%(42.5-100) (p=0.009) following treatment. There were significant reductions in the interference of the pain with: general activity from 6(4.25-8.75) to 2.5(0-6.75), (p=0.006); mood from 6(2-8) to 0(0-5), (p=0.004); walking ability from 7.5(4-8.75) to 3.5(0.25-6), (p=0.004); normal work from 5.5(3.5-8) to 1.5(0-5), (p=0.009); relations with other people from 4(2-8) to 0(0-3.5), (p=0.006); sleep from 6(3.25-9.5) to 1.5(0-5.75), (p=0.004); enjoyment of life from 6(2.75-8.5) to 1.5(0-6), (p=0.005). All patients found the treatment acceptable. We conclude that patients reported significant improvements in pain, physical and emotional functioning, and sleep three months following treatment with this viscosupplementation treatment.
