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Orthopaedic shoulder clinic diagnosis and treatment plan audit

Helen Oakes (East Kent Hospitals University NHS Trust, Ashford, UK)

Clinical Governance: An International Journal

ISSN: 1477-7274

Article publication date: 24 April 2009




The orthopaedic consultants at East Kent Hospitals NHS Trust had questioned whether the Extended Scope Practitioners (ESPs) and consultants were forming a comparable diagnosis and treatment plan. This audit aims to identify what percentage of patients received a comparable diagnosis from the ESPs and the orthopaedic consultant and to find out what percentage of patients referred from the ESP to the orthopaedic consultant for a surgical opinion underwent surgery.


The medical notes of a sample of patients from the ESP clinic who had been referred to the orthopaedic consultant were reviewed retrospectively and the following information was documented in a table: the ESP's diagnosis, the consultant's diagnosis and whether the patient underwent surgery.


The audit found a 31 per cent partially and 65 per cent fully comparable diagnosis rate between the consultant and the ESPs, and the ESPs predicted which patient would undergo surgery in 86 per cent of cases. The results of this audit compared favourably with the benchmarks set.

Practical implications

Audits such as this will hopefully help improve consultant, ESP, manager and patient confidence that the ESP is a valuable and effective member of the orthopaedic team.


A search for papers relating to ESP services on the healthcare databases AMED, BNI, CINAHL and MEDLINE found a number of articles which have reported on audits of ESP services but to date not with regard to shoulder problems. The paper may encourage other clinicians to do similar audits, supporting the expansion of ESP services within the NHS and ultimately improving patient care.



Oakes, H. (2009), "Orthopaedic shoulder clinic diagnosis and treatment plan audit", Clinical Governance: An International Journal, Vol. 14 No. 2, pp. 126-133.



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Copyright © 2009, Emerald Group Publishing Limited

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