The World Health Organisation (WHO) Surgical Safety checklist is an evidence-based tool shown to reduce surgery-related morbidity and mortality. Despite audits showing 96% checklist compliance, our hospital had 3 surgical never events in 10 months, 2 of which were in orthopaedics. By March 2018, the authors aimed to achieve 100% compliance with all 5 sections of the WHO Five Steps to Safer Surgery bundle for all surgical patients. Additionally, the authors aimed to assess the impact of the quality of bundle delivery on preventable errors related to human factors. Quantitative assessment involved direct observations of compliance in theatres. Qualitative data in the form of rich, descriptive observations of events and discussions held during checklist delivery was analysed thematically. Interventions included trust-wide policy changes, awareness sessions, introduction of briefing and debrief proformas and documented prosthesis checks. For elective surgeries, checklist compliance increased to 100% in 4 of 5 sections of the bundle. The incidence of reported preventable critical incidents decreased from 6.7% to 2.4%. A chi-squared test of independence demonstrated a significant relationship between the implementation of changes and completion of the checklist, X2 (1, N = 1019) = 25.69, p < 0.0001. Thematic analysis identified leadership, accountability, engagement, empowerment, communication, and teamwork as factors promoting effective checklist use. Our findings highlight the benefits of a qualitative approach to auditing checklists. Exploring the role of human factors and promoting staff awareness and engagement improves checklist compliance and enhances its effectiveness in reducing surgery-related adverse outcomes.
25 First metatarso phalangeal joint replacements using the MOJE implant were prospectively assessed. There were 13 females and 10 males, with an average age of 60 years (range 45–71 years). The main indication for surgery was a symptomatic Hallux Rigidus. The minimum follow up period was 2 years (range 24–38 months). The patients were assessed before and after surgery using the AOFAS (American Orthopaedic Foot and Ankle Society Hallux Score). The mean pre operative AOFAS score was 45.60 and this improved to 85.63 after surgery. There was a significant improvement in the sub scale for pain, from 4.58 pre operatively to 31.25 post operatively. A 9.50 improvement in the range of motion was noted. The authors conclude that their study demonstrates that the use of the MOJE implant for the treatment of Hallux Rigidus is a safe and useful option, although a more long term follow up is indicated.
This small study was a pilot for a larger ongoing study to look at the long-term results of Wilson’s osteotomy. Eight patients and thirteen feet were reviewed at a minimum of twelve years post operatively (twelve to eighteen years). Photographs were obtained of their feet, also pedographs, and pre and post op X-rays. Clinical assessments were done and the patient outcome was quantified using the American Academy of Foot and Ankle Surgeons scoring system which includes a shoe comfort score. The findings show that in the younger population (less than 40 years old) there were minimal symptoms (pain and stiffness), all showed callosity formation and none had a recurrence. The older group (over 40 at operation) were more symptomatic, all showed callosity formation and there was a recurrence rate of more than 40%.
