A ‘united’ approach to orthopaedics

Patients needing orthopaedic surgery are being seen quicker and going home sooner thanks to a revolutionary trial at Lincolnshire’s hospitals.

Now almost one year on, a trial aiming to reduce cancellations, waiting times and the amount of time patients spend in hospital is proving a success and improving patient experience.

The service at United Lincolnshire Hospitals NHS Trust (ULHT) treats those with injuries and conditions of the musculoskeletal system (bones, joints, ligaments, tendons, muscles and nerves).

The trauma and orthopaedic ‘hot and cold’ site trial saw an introduction of ‘hot’ sites where trauma (emergency/unplanned) orthopaedic surgery is carried out and ‘cold’ sites where elective (elective/planned) orthopaedic surgery takes place. This means that the majority of patients requiring urgent treatment for trauma – broken bones and soft tissue injuries – would go to Lincoln or Boston, with some of this care given at Grantham. Those needing elective orthopaedic surgery would go to Grantham if they required an overnight stay as an inpatient, or Louth if they were able to go home on the same day.

ULHT is one of just eight trusts in the country to have trialled the ‘hot’ and ‘cold’ split so far. The trials were initiated by Getting It Right First Time (GIRFT), a national clinical improvement programme working with NHS trusts to tackle unwarranted variation in the way services are delivered.

Led by consultant orthopaedic surgeon Professor Tim Briggs, GIRFT recommends separating emergency (hot) and elective orthopaedic surgery (cold) onto different sites, to reduce length of stay, improve infection rates and free up emergency beds.

Mark Brassington, Chief Operating Officer at United Lincolnshire Hospitals NHS Trust, said: “Taking part in this trial has massively improved the service for our patients. Before the trial, busy periods leading to bed pressures in our hospitals meant that around 900 patients each year had their elective orthopaedic surgery cancelled. This wasn’t good enough for our patients and we needed to take action. Since the trial began, the majority of elective patients have been treated at Grantham hospital and not a single one of them have had their surgery cancelled due to bed pressures – an incredible improvement.”

Patients recover better in their own homes and over the last year the amount of time patients are spending in hospital has reduced. Patients who have had a full hip replacement will now spend an average of only 2.5 days in hospital, down from 3.6 days before the trial. Waiting times for first appointments and any surgery that’s needed are also reducing, with most patients now waiting within the recommended 18 weeks.

Patients needing a partial knee replacement are now being treated at Louth hospital and thanks to a new innovative approach, patients can return home on the same day.

Roger, an 80-year-old patient from Welton recently had the procedure.
He said: “The entire experience was very straightforward. I got to Louth hospital early, everything was explained clearly to me and before I knew it I’d had the surgery and was awake again. It all went well and I returned home the same day – I didn’t mind travelling to have it done.

“I’m very active, I walk a lot and play golf three times a week so it’s great that I was back at home and on my feet so quickly.”

In addition to the move to ‘hot’ and ‘cold’ sites, a dedicated ward was opened at Grantham hospital so that all patients requiring an overnight stay following their surgery have a bed ready for their recovery.

There have also been improvements to the way patients are seen when coming into A&E with an orthopaedic problem (e.g. a broken ankle), as new ‘hot clinics’ were introduced at Lincoln and Boston so that patients have better access to specialist care and better access to the right expertise at the right time – rather than waiting in A&E.

Mr Brassington added: “This trial would not have been as much of an incredible success if it wasn’t for our staff who have adapted and embraced this new way of working. The whole team should be proud of the service they can now offer their patients.

“I would encourage anyone needing orthopaedic treatment to consider coming to ULHT so they can benefit from our improved service.”

The future for trauma and orthopaedic services in Lincolnshire includes the opening of a ‘centre of excellence’ – a great opportunity for the service to develop further.

Professor Briggs commented: “We know that separating elective orthopaedic surgery from trauma provides better quality outcomes for both groups of patients. The success of the trial is testament to the hard work and commitment of the team at ULHT. They’ve really embraced this new way of working and that clearly shows in the improved experience for patients.”