JTO - March 2018
Volume 6 Issue 1
From the Executive Editor
Welcome to the first issue celebrating the Centenary of the British Orthopaedic Association. Our feature article by Ian Stephen and David Adams traces not only the development of our Association but also provides a fascinating outline of how our specialty has developed over the last 100 years. Starting from a meeting of 12 members on 2nd February 1918, we have grown to a membership of almost 5000 with just under 2000 attending our last Congress.
We are living in times of overt rationing of elective healthcare, delaying surgery on those same patients because of winter pressures due to a lack of resources and the inability of social care to keep vulnerable patients in their homes or provide suitable care to allow their return to the community. This does not absolve us of responsibility to ensure the care we do offer is efficient and effective. We have three articles focussing on the “Getting It Right First Time” project led by Prof Tim Briggs. He explains how variation is rife across the spectrum of medical and surgical care, and outlines the substantial impact of addressing the problems. Processes and practices have to change if any benefit is to be gained and two further articles look at how we may use GIRFT evidence to reduce costs and improve outcomes.
The financial theme continues in two paired articles by David Johnson and Ro Kulkarni that explore the somewhat arcane world of coding and tariff. I implore you to read them as they give a straightforward and comprehensible account of the topic which is so important to maintaining the viability of your department.
Teamwork within our specialty and across specialties is vital. The outcomes of hip fracture surgery are largely reliant on developing an effective system of care. Janet Lippett describes how she and her team transformed the pathway for these frail and elderly patients.
Pressure on the junior members of the orthopaedic team has a negative impact on continuity of care, patient experience and particularly on the educational development of young surgeons. The Medical Associate Professions may well be the solution. Karen Daly and Jeannie Watkins explain who they are what they can do.
As you explore this edition, consider what our forebears from 1918 would think about the content and wonder what the 2118 volume will look like.
Phil Turner – BOA Vice President
Reference Lists
An Update from the GIRFT Programme
References
1. www.kingsfund.org.uk/publications/tackling-variations-clinical-care.
2. National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) conduct world class applied health research which will have a direct impact on the health of patients with long term conditions and on the health of the public. CLAHRCs are collaborations between universities, the NHS (local service providers and commissioners), local authorities, industry, patients and the public, the local Academic Health Science Network (AHSN) and other relevant organisations in the region. By working together, CLAHRCs can deliver nationally relevant research that responds directly to the needs and priorities of their region, and increase the speed at which research evidence is put into practice, locally and nationally.
Hip Replacements: Charnley to the Future
References
1. The operation of the century: Total hip replacement, Ian D Learmonth, Claire Young, Cecil Rorabeck. The Lancet, Vol 370, October 27, 2007.
2. A tribute to Sir John Charnley (1911 – 1932), John Older FRCS. Clinical Orthopaedics and Related Research No 211, October 1986 pp 23.
3. The organisation of a Special Centre for Hip Surgery. John Charnley. Internal Publication No 39 page 3.
4. What is the benefit of introducing new hip and knee prostheses? Anand et al J Bone Joint Surg Am 2011 Dec 21; 93 Suppl.
Improving Quality of Care and Reducing Length of Stay for Hip Fracture Patients
References
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4. Gupta A. Orthogeriatric service: models of care. Geriatric Medicine. 2005; 35(6):43-9.
5. Lippett J. Principles of Orthogeriatrics. In: Gosney M, Harper A & Conroy S, eds. Oxford Desk Reference Geriatric Medicine. Oxford: Oxford University Press. 2012; 454-455.
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8. Scottish Intercollegiate Guideline Network (SIGN). Management of hip fracture in older people: a national clinical guidance. SIGN, 2009; 111:1-56.
9. British Orthopaedic Association. The care of patients with fragility fracture (“The blue book”). Chandlers Printers Ltd, East Sussex 2007.
10. National Hip Fracture Database 2009 Annual Report
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12. National Institute for Health and Care Excellence. NICE guideline CG124: hip fracture management. 2011; updated 2014. www.nice.org.uk/guidance/cg124 (accessed on20th November 2017).
13. Hawley S, Javaid K, Prieto-Alhambra, LippettJ, Sheard S, Arden N, Cooper C, Judge A. Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age and Ageing. 2016; 45(2): 236-42.
14. Neuburger J, Currie C, Wakeman R, et al. The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data. Med Care 2015;53:686-91.
15. Department of Health. Payment by results guidance for 2010–11. Leeds: Payment by Results team, Department of Health, 2010.
16. Royal College of Physicians. Best practice tariff (BPT) for fragility hip fracture care user guide, 2010.
17. Gupta A. The effectiveness of geriatrician-led comprehensive hip fracture collaborative care in a new acute hip unit based in a general hospital setting in the UK. J R Coll Physicians Edinburgh. 2014;44:20-6.
18. Royal College of Physicians. 2016-17 Census (UK consultants and higher specialty trainees). www.rcplondon.ac.uk/projects/outputs/2016-17-census-uk-consultants-and-higher-specialty-trainees (accessed 20th November 2017).
19. NHFD website www.nhfd.co.uk/20/hipfractureR.nsf/ResourceDisplay.
The Physician Associate in Trauma and Orthopaedic Surgery
References
1. The Department of Health (2006) The Competence and Curriculum Framework for the Physician Assistant, DH, Revised 2012. static1.squarespace.com/static/544f552de4b0645de79fbe01/t/557f1c1ae4b0edab35dd92cf/1434393626361/C CF-27-03-12-for-PAMVR.pdf (Accessed 1st March 2016).
2. General Medical Council. Delegation and referral. 2013. www.gmc-uk.org/guidance/ethical_guidance/21187.asp (accessed 7th March 2016).
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Psychosocial Aspects of Challenge and Threat Appraisal in Orthopaedic Training
References
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2. Elliot AJ. Handbook of approach and avoidance motivation: Taylor & Francis; 2008.
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5. Feinberg JM, Aiello JR. The effect of challenge and threat appraisals under evaluative presence. Journal of Applied Social Psychology. 2010; 40(8):2071-104.
6. McGrath JS, Moore L, Wilson MR, Freeman P, Vine S. 'Challenge' and 'threat' states in surgery: implications for surgical performance and training. BJU Int. 2011; 108(6):795-6.
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9. Vine SJ, Freeman P, Moore LJ, Chandra-Ramanan R, Wilson MR. Evaluating stress as a challenge is associated with superior attentional control and motor skill performance: testing the predictions of the biopsychosocial model of challenge and threat. Journal of experimental psychology: applied. 2013; 19(3):185.
Promoting Quality Training and Improving Morale through a Trainer-Trainee Dialogue and Partnership
References
1. Temple J. 2010. Time for training: a review of the EWTD on the quality of training. Department of Health, London.
2. Wraight PJ, Forward DP, Manning P. 2012. The impact of the European Working Time Regulations on Orthopaedic Trainee Operative Experience. Ann R Coll Surg Engl (Suppl). 94:156–158.
3. Fitzgerald JEF, Caeser BC. 2012. The European Working Time Directive: A Practical review for surgical trainees. Int J Surg. 10:8,399–403.
4. Pereira EAC, Dean BJF. 2009. British surgeons' experiences of mandatory online workplace-based assessment. J R Soc Med. 1:102(7),287–293.
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9. Nicol G, Dalgleish S, MacInnes A. 2017. The Implementation of Rota Changes to Optimise Training Opportunities in the East of Scotland. J Orthop Trauma. 5:4,44-45.
10. Dalgleish S. 2017. Holistic view is needed to tackle bullying in the healthcare profession. BMJ. 356:j750.
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