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Improving Hip Replacement Care: Real-Time Monitoring of Patient Outcomes

Learn how UHCW's Arthroplasty Virtual Surveillance Service uses PROMs and x-rays to monitor hip replacement patients in real time, improving care pathways. Explore the benefits and challenges of this innovative approach.

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Improving Hip Replacement Care: Real-Time Monitoring of Patient Outcomes

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  1. Hip Replacements – improving the care pathway Measuring and monitoring patient outcomes in real time and in the longer term Lesley Hugill RGN BSc (Hons) DPSN Clinical Nurse Specialist Trauma & Orthopaedic Department UHCW NHS Trust lesley.hugill@uhcw.nhs.uk

  2. UHCW Arthroplasty Virtual Surveillance Service • Time line: • 2004 a DoH policy research programme • 2006 at UHCW virtual’ arthroplasty surveillance plan • April 2008 The new Standard NHS Contract for Acute Services • Jan 2009 this commenced at UHCW (post op) • April 2009 DoH pre op PROMs commenced

  3. Problem: • Large volume of arthroplasty patients • Large majority of patients satisfied, no problems • Important to follow up patients to spot problems • Heavy burden on clinic time to review large number of patients with low rate of problems.

  4. Solution: • Filter mechanism to screen all patients • Select only problem patients for clinic

  5. UHCW Arthroplasty Virtual Surveillance Service • The process: • Pre-op questionnaire completed using multiple Patient Reported Outcome Measures (PROMs) • Surgery performed • The Clinical Nurse Specialist (CNS) receives a monthly list • CNS validates, then admin support mail merges and sends forms • CNS checks if there are current x-ray views • X-rays requested as per protocol.

  6. UHCW Arthroplasty Virtual Surveillance Service • Receive the returned forms & checks the x-ray date • Questionnaires are transferred onto the patient’s e-form • Secretaries are sent a quarterly ‘table of patients for virtual review’ • The consultant/team then perform a virtual clinic, reviewing PROMS and x-rays • Outcome is documented on hospital electronic record system, standard clinic letter to GP is generated • Hip surveillance post op follow up.

  7. UHCW Arthroplasty Virtual Surveillance Service • The 1st year results • Total patients = 209 • Functional outcome response 178 (85.2%) • Radiographic response 176 (84.2%) • 2nd year (numbers) • Data still being processed.

  8. UHCW Arthroplasty Virtual Surveillance Service • Consultants happy to be able to devote more clinic time to more needy patients • Patients happy to know they are still under review without having to attend clinics • Management happy with more efficient use of clinic time.

  9. Problems and pitfalls: • No admin support for virtual surveillance • IPM/coding not correct • CNS validating the info from CRRS • Patients unable to complete the questionnaire (esp. Oxford score Q1) • Patients not returning the questionnaires.

  10. Problems and pitfalls (cont): • Virtual clinic list not populated by secretary • Virtual clinic list not reviewed by consultant • Outcome not recorded by consultant • Closing the loop – confirming reviews have taken place.

  11. UHCW Arthroplasty Virtual Surveillance Service • Beware risk of clinics becoming exclusively for unhappy patients • Everyone needs some positive feedback! • Routine protocol now real visit at 6/52 and one year, then virtual if OK.

  12. UHCW Arthroplasty Virtual Surveillance Service • Plans: • Currently patient is sent paper form, returns paper form (printing and postage cost x 2) • Staff copy data onto electronic form (staff time, potential for error) • Hope to develop online form for patients to log on and directly enter their data onto our database.

  13. References: • Primary total hip replacement: a guide to good practice; 2006. British Orthopaedic Association. [London] • Long-term follow up care recommendations after total hip and knee arthroplasty: results of the American Association of Hip and Knee Surgeons' member survey. Teeny SM, York SC, Mesko JW, et al. (2003) J Arthroplasty; 18:954 • The Cost-effectiveness of Routine Follow-up After Primary Total Hip Arthroplasty. Bolz, KMD, Crawford, RW, Donnelly, B. et al. (2010) The Journal of Arthroplasty Vol. 25 No. 2. • Guidance on the routine collection of Patient Recorded Outcome Measures (PROMs) 2009/2010 NHS. Department of Health

  14. UHCW Arthroplasty Virtual Surveillance Service ? orthop orthop æ æ dics dics UNIVERSITY OF WA WICK UNIVERSITY OF WA WICK

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