Project Qvewiew and Aims
Arthroplasty follow-up practice varies
considerably between surgeons, units and
regions: some patients are discharged at six
weeks whilst others may remain on indefinite
biannual review. This project was aimed to
Do
New targeted follow up algorithm launched
shown in the figure below.
OP 6/52
1Y
5Y 5Y
2Y
match follow-up need with available resources
to improve follow-up practice.
2Y 5Y
5Y
Methods
Stakeholders analysis and engagement
Arthroplasty lead and BOA Fellow key drivers
Supported by Lower limb arthroplasty Surgeons
Re-audit of overdue patients for follow-up using
newly developed targeted follow-up pathway
Environmental a nalysis
Concerns about inability
Act
Sustainability analysis
prosthesis early
Trust management supportive
to
identify failing
Study
used to
identify
problems, staff education and booking system
modification planned to minimise effect of those
problems
Q u a I ity I m prove m e
nt strateg i e s
Process mapping identified 425 arthroplasty
patients in our unit as being overdue for followup by our conventional patient tracking system,
Progress to date
Audit results - overdue patients for followup
reduced from 452 to125 as shown below.
Workload reduction
Plan Do Study Act (PDSA) cycte
500
Action Planning
New targeted follow-up algorithm developed
400
after negotiation with stakeholders.
300
* lhe algorithm was based upon probability of
failure as per typical Kaplan Meier survival
analysis (shown in ihe figure below)with respect
to last known review and time since surgery.
Hqwlredics ABG Cup Survivai wer 26 vears
140
200
100
0
ffi
Benefits
lntroduction of new targeted follow-up algorithm
led to a significant reduction in workload (327
patients) in follow up clinics and a large financial
saving (t9,265.00) whilst not reducing quality of
@
3C
tc
JLI
patient's follow-up care. Cost per follow-up is
f2.47 per year per patient for 6 planned follow-
so
4()
30
ups in 20 years for this regimen.
20
0489€
144
fime (mtlr)
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Next Phase
Improve staff education to increase compliance
to adopt targeted algorithm and make it part of
induction programme for trainee doctors.