RNOH plays key role in national review of orthopaedics

The British Orthopaedic Association (BOA), the body that represents the professional interests of orthopaedic surgeons across the UK, has today published a report reviewing current practices and outcomes of NHS hospitals providing orthopaedic surgery in England, to identify and quantify variation in clinical outcomes, processes, patient experience, patient pathways, network arrangements, financial impacts and waiting times.

The report, and pilot study upon which it is based, have been undertaken by a team from RNOH, led by Professor Tim Briggs an eminent orthopaedic surgeon at the Trust and Trust Chief Executive Rob Hurd. The work has including developing a clinically-led approach to reviewing the total pathway of adult elective orthopaedics and spinal activity, and considered all efficiencies including clinically unsupported variations of practice in terms of device and procedure selection, price benchmarking, infection rates, quality outcomes and litigation costs.

Professor Tony Goldstone, Chair of RNOH, commented, “RNOH, is the largest orthopaedic hospital in the UK, and is regarded as a leader in the field of orthopaedics both in the UK and world-wide. It is therefore wholly appropriate that it should be the birthplace of the GIRFT project which has developed and honed this highly effective approach to engaging Trusts and clinicians and using data as a powerful driver for improvement in elective orthopaedic care.”

The report Getting It Right First Time (GIRFT) builds on Professor Tim Briggs’ original research in 2012 which suggested ways in which extensive savings and improvements could be made in elective orthopaedics by hospitals to ensure continuing high quality care and access for patients within the financial constraints of the NHS. NHS England funded the GIRFT pilot as a national professional pilot across England and the project was then hosted at RNOH, on behalf of the BOA.

The pilot has identified significant variations in practice and outcomes in terms of device and procedure selection, clinical costs, infection rates, readmission rates, and litigation rates. For example, long term deep infection rates for hip and knee replacement vary between 0.2% and 5% and statistics show an average return to theatre as a result of complications of between 0% and 7%. During conversations with Trusts it also came to light that there appears to be a similar range of variation in the prices paid for hip and knee implants above and beyond what could be clinically justified.

Chief Executive, Rob Hurd, reflected, “We have also clearly demonstrated that there is significant scope to tackle many of these variations and drive short, medium and longer- term improvements in quality of delivery through adopting best practice, reducing supplier costs (for example of implants) and thereby generating savings. This is an exciting opportunity to drive quality and efficiency.”

The GIRFT team summarises their measurable impacts for orthopaedics as follows:

Short Term Medium Term Long Term
Reductions in:
  • Prostheses costs
  • Loan kit costs
  • Readmission rates
  • Length of stay
  • Surgical site infections
Reductions in:
  • National variation for procedures
  • Outliers in national registries
  • Infection/complication rates
Reductions in:
  • Revision surgery
  • Readmissions
  • Litigation numbers and rates

This work has gathered overwhelming support from clinicians across the NHS, as this is being driven clinically with the work taking place peer to peer. The GIRFT team conducted deep dive visits to 120 Trusts comprising of some 205 hospitals that provide elective care to understand first-hand the differing practices and challenges to identifying realistic and achievable efficiency opportunities.

Professor Briggs commented, “Our approach has enabled us to take a consolidated view of all the available data and metrics relating to each Trust’s clinical and financial performance and to then engage with each management team and group of clinicians to use this evidence to reflect on variation in clinical practice, management approach and variation in prosthesis selection.”

Details of the pilot are available at www.rnoh.nhs.uk, gettingitrightfirsttime.co.uk and www.boa.ac.uk

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