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The first phase of this study developed a multi‐professionally agreed list of adverse events for clinical incident reporting in Trauma and Orthopaedics. This follow‐up study aims to evaluate the effectiveness of the adverse event list.

Two follow‐up questionnaires were sent to healthcare professionals working in Trauma and Orthopaedics in two of the participating National Health Service (NHS) Trusts (n=247 for the first questionnaire and n=240 for the second questionnaire). Trends in routine incident reporting data were also monitored over a two‐year period to determine the impact of the adverse event list on levels of adverse event reporting.

The questionnaires indicated that awareness about the adverse event list was good and improved between questionnaires. However usage of the adverse event list appeared to be poor. Multiple regression analysis with the dependent variable count of orthopaedic incidents suggested that the adverse event list had little, if any impact on levels of reporting in Trauma and Orthopaedics.

The results of this study suggest that a practical tool, such as the adverse event list has little impact on incident reporting levels.

The aim of this study was to develop a multi‐professionally agreed list of adverse events, which may act as a prompt for clinical incident reporting in trauma and orthopaedics and to determine what healthcare professionals understand by the term adverse event. A modified Delphi process with healthcare professionals working in trauma and orthopaedics (242) in three NHS trusts was performed. The process involved initial brainstorming sessions, a two‐round Likert‐style postal questionnaire and final focus group discussion. The initial brainstorming sessions generated a list of 224 adverse events to be included in the first round of the postal questionnaire. They included 83 causes of adverse events, 36 health and safety related adverse events and 105 clinical adverse events. Following the second round questionnaire and focus group discussion, a final list of 20 adverse events was produced. There were variations between professional groups in terms of validity scoring of individual adverse events. Overall, medical staff gave a lower rating to the adverse events than the other two professional groups. There were also variations between professional groups in terms of response rates. The modified Delphi process proved to be a successful tool for generating a multi‐professionally agreed list of adverse events and for understanding what healthcare professionals understand by the term adverse event.

The value of pre‐admission assessment clinics prior to elective surgery has been previously reported. However, no assessment of their value to orthopaedics in particular has been made. This preliminary study shows that such clinics can bring about a significant saving in theatre time and hence improved efficiency. Most cancellations at the clinic resulted from change in orthopaedic requirement and not from anaesthetic contraindications.

Lost X‐ray films waste time, delay treatment, and may necessitate a patient being exposed to further radiation. Audit of a 132‐bed orthopaedic and trauma department over a 2‐month period showed that 16 patients' X‐ray films were lost. Fifteen (93%) had been stored in anonymous polythene packets. Only 5 (31%) were found within half an hour, and a mean of 67 minutes' working time was occupied locating each one. Recognition of why and where they were lost reduced the number of losses.

Admissions planning decides on the number of patients admitted for a specialty each day, but also on the mix of patients admitted. Within a specialty different categories of patients can be distinguished on behalf of their requirement of resources. The type of resources required for an admission may involve beds, operating theatre capacity, nursing capacity and intensive care beds. The mix of patients is, therefore, an important decision variable for the hospital to manage the workload of the inflow of patients. In this paper we will consider the following planning problem: how can a hospital generate an admission profile for a specialty, given a target patient throughput and utilization of resources, while satisfying given restrictions? For this planning problem, we will develop an integer linear programming model, that has been tested in a pilot setting in a hospital. The paper includes an analysis of the planning problem, a description of the model developed, an application of a specialty orthopaedics, and a discussion of the results obtained.

At the one‐stop carpal tunnel syndrome clinic, patients undergo neurophysiological studies followed by clinical assessment by the orthopaedic consultant on the same day. Patients with paraesthesia or numbness in the median nerve distribution for greater than three months duration without a history of a previous soft tissue neck injury were selected for assessment in the one‐stop carpal tunnel syndrome clinic based on a proforma completed by their general practitioners. Data of patients attending the one‐stop carpal tunnel syndrome clinic over a ten‐month period were compared with that over the same period from a conventional hand clinic. A total of 77 patients attended the one‐stop carpal tunnel syndrome clinic over a ten‐month period. The mean time from referral to surgery was 23 weeks in this group compared to 44 weeks for a conventional clinic. On average, the one‐stop carpal tunnel syndrome clinic reduced the time from referral to surgery by 21 weeks. The one‐stop carpal tunnel syndrome clinic is convenient and cost effective for patients and hospitals.

The purpose of this paper is to investigate cost effectiveness, diagnostic rates, surgical percentage and appropriateness for orthopaedic referrals and number of patients able to be seen in orthopaedic triage from GP orthopaedic referrals.

The study involved triaging paper referrals for orthopaedic outpatients to an interface service, orthotics or continue normal route. Data were collected on outcome of the interface appointment and outcomes for those patients referred to orthopaedics from the appointment.

The study demonstrated a 27.3 per cent cost saving from the normal orthopaedic route with 86.1 per cent of patients able to be managed by an extended scope physiotherapist (ESP) without requiring orthopaedic assessment. Appropriateness of onward orthopaedic referrals was 80.5 per cent with surgery conversion rate of 75 per cent.

Although triage and ESP positions have been studied before, this is the first known study to look at cost effectiveness across the patient pathway despite this being a large reason for the creation of these positions. Further larger studies are required to build upon this base in terms of demonstrating the cost effectiveness of the value of these positions.

A simple, reproducible model for reporting adverse events was developed in order to promote cultural awareness and acceptance of risk management within the authors’ department. A departmental proforma was created and prospective reporting of adverse events was encouraged. In the six months prior to commencing this study only four adverse incidents were reported. Following the introduction of the proforma 64 critical incidents and near‐misses were reported in the one‐year period. In conclusion a simple model for reporting critical incidents and near‐misses has been established. This has fostered a cultural change within the department and all members of staff feel more comfortable with reporting such incidents. The process is seen as educational and an important part of continuing professional and departmental development. Protocols and changes in organisational practice have been developed to reduce and prevent the occurrence of adverse events and offer patients continuous improvement in care.

The purpose of this paper is to discuss the scepticism that persists among medics regarding appropriateness of some aspects of services provided by extended scope physiotherapists (ESPs). This paper aims to highlight the extent and appropriateness of surgical and radiological referrals by ESPs working in an adult orthopaedic service.

The patient pathway following ESP assessment was audited over 31 months. Parameters explored included ESP referral rates to orthopaedic consultants; the percentage of patients where the entire episode of care was managed by the ESP; whether orthopaedic referrals were appropriate in terms of surgical interventions; and numbers of radiology referrals specifically for knee or lumbar complaints.

Of the patients, 79 per cent had their entire episode of care managed by ESPs. Of the patients, 9 per cent were referred on for a surgical opinion (of which 42 per cent knees, 20 per cent lumbar). 13 per cent were referred for x‐rays, 10 per cent for magnetic resonance imaging. Of the patients referred on for surgical opinion surgical intervention was appropriate in 89 per cent of cases.

Data from an ESP service with broad guiding protocols in a specific hospital are not readily extrapolated to ESPs elsewhere. Appropriateness of onwards referrals was based on the opinions of consultants to whom patients were referred. The potential benefit of a second opinion even if surgery is not offered is not taken into account by this model.

These audits reinforce the impact ESPs have on efficiency within orthopaedics. They document referral rates for x‐rays and magnetic resonance imaging by ESPs for lumbar and knee complaints that may benefit units proposing new ESP services.

This paper reinforces published data on ESP management of the entire episode of care of the majority of referrals to orthopaedics, and on the highly appropriate nature of onwards referrals. Documented for possibly the first time, data regarding investigations for lumbar and knee disorders highlight low referral rates.

A postal questionnaire was successfully used to determine general practitioner views about the quality of the health care services available to their patients. In the case of hospital services, 75 of the 112 respondents (67 per cent) chose orthopaedics and 52 (46 per cent) chose ophthalmology as services in need of improvement. Other hospital‐based services, chosen by at least ten general practitioners, were gynaecology, gastroenterology/endoscopy, medicine for the elderly, radiology/ultrasound, psychiatry and physiotherapy. Only 74 general practitioners chose community services, with health visiting being chosen by 25 respondents, district nursing by 24, physiotherapy by 20 and chiropody by 18, as being in need of improvement. The survey was intended to provide a basis for a dialogue between clinicians, managers and general practitioners, about how the quality of services could be improved and how they might be developed in the future.