An innovative orthopaedic project has delivered a dramatic 200% increase in the number of new referrals seen at orthopaedic outpatient clinics and an equivalent increase in the number of hip and knee replacements performed per month.
The approach used by the Glasgow Royal Infirmary orthopaedic team was to consider how to best use the time and skills of all their clinical staff to develop a service providing the appropriate treatment for patients with shorter waiting times.Sub-specialty teams (hip, knee, foot and ankle etc) were formed, each led by a consultant with a special interest in the area who takes overall responsibility for their clinical subspecialty.
Extended scope practitioners (ESPs) - physiotherapists, nurses and podiatrists – have received highly specialised training from the appropriate consultants.The result has been the majority of outpatients are now seen by ESPs who decide on the management of the patient -whether that be surgery, investigation or discharge with advice.The ESPs also follow up patients after their surgery to make sure they are recovering well.
The consultant supervises the entire process, sees the most complex cases and is always on hand to give advice or review a particular patient if required.
There are a stunning 83 clinics a week run by nurses, physiotherapists, podiatrists and medics. This multidisciplinary team working has contributed to the number of patients seen a month in outpatient clinics rising by over 200% from September 2004 to May 2005 (249 to 788 new patients per month). By May, the number of people waiting longer than 26 weeks for an outpatient appointment had fallen by 58%.
To accommodate some of these new clinics, the Centre for Change and Innovation have funded the redevelopment of the old A&E department at Glasgow Royal Infirmary into an orthopaedic outpatient department. Eight extra clinic rooms will enable 600 patients to be seen a month in more appropriate facilities.Patients are already being seen in this new department, with the building work due to be finished in September 2005.
The effect of substantially increasing the number of outpatients seen is to proportionately increase the number of patients waiting for surgery.The above outpatient system allows surgeons to spend less time in clinics and more time operating.The result has been to more than double the number of hip and knee replacements performed, increasing by over 200% from 25 per month in January 03 to nearly 80 per month in April and June of this year.
"The key to our success has been the flexibility of our integrated team" says Mr Rymaszewski, Consultant Orthopaedic Surgeon and Clinical Director.Everyone works together to make sure that no theatre or clinic time is wasted, and that each patient is seen by the most appropriate person, who is often not a doctor.This means we are well on our way to achieving the government target of no patient waiting longer than six months for an outpatient appointment or surgical procedure, by December 2005."
The team are proud of the changes they have made over recent months, and plan to continually evaluate and improve the way they work to provide the best care possible to their patients.
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