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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_16 | Pages 11 - 11
17 Nov 2023
DELIVERING SUSTAINABLE CHANGE OF POSTOPERATIVE CARE DOCUMENTATION PRACTICES IN SPINAL SURGERY THROUGH QUALITY IMPROVEMENT FRAMEWORKS
Wahdan Q Solanke F Komperla S Edmonds C Amos L Yap RY Neal A Mallinder N Tomlinson JE Jayasuriya R
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Abstract

INTRODUCTION

In the NHS the structure of a “regular healthcare team” is no longer the case. The NHS is facing a workforce crisis where cross-covering of ward-based health professionals is at an all-time high, this includes nurses, doctors, therapists, pharmacists and clerks. Comprehensive post-operative care documentation is essential to maintain patient safety, reduce information clarification requests, delays in rehabilitation, treatment, and investigations. The value of complete surgical registry data is emerging, and in the UK this has recently become mandated, but the completeness of post-operative care documentation is not held to the same importance, and at present there is no published standard. This project summarises a 4-stage approach, including 6 audit cycles, >400 reviewed operation notes, over a 5 year period.

OBJECTIVE

To deliver a sustainable change in post operative care documentation practices through quality improvement frameworks.

Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 584 - 584
1 Aug 2008
BILATERAL SIMULTANEOUS TWO SURGEON KNEE REPLACEMENT – EFFICIENT, SAFE AND EDUCATIONAL
Tomlinson JE Hannon E Sturdee SW London NJ
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Aim: To assess the safety and efficiency of bilateral simultaneous total knee replacement surgery using a retrospective notes based review.

Methods: We performed a retrospective case note review of a series of 112 bilateral simultaneous knee replacements performed over a five year period in a district general hospital. (224 joints – 142 total joints, 82 unicompartmental). The procedures were all performed by a consultant knee surgeon operating alongside a knee fellow. Patients were only offered bilateral procedures if in ASA class I/II. (any borderline candidates were referred for anaesthetic assessment). Results were obtained for a number of parameters to assess the safety of this technique by measuring rates of both minor and major complications. Data was also gathered to assess the efficiency of the technique – measuring both tourniquet times and length of stay.

Results: Over the period of five years there were no deaths or major complications reported. There were three cases of DVT (2.6%) and one case of PE (0.9%). There were three cases of superficial wound infection (2.6%), one of joint infection (0.9%) and one of aseptic loosening (0.9%). Average tourniquet time was 76 minutes with an average length of stay of 8.6 nights.

Conclusion: Bilateral simultaneous knee replacement is a valuable technique which offers the patient a single operation and recovery period, and return to normal life. In addition, the complication rates are acceptable, unlike several studies looking at bilateral procedures performed back to back. It also offers an excellent training opportunity for the 2nd surgeon to operate under close supervision. In an increasingly time pressured health service we believe this procedure is an efficient and safe technique when used in suitable patients.