What is the challenge your project is going to address and how does it connect to your chosen theme?

Currently the Trust carries out on average 440 primary joint replacements in a year, that are delivered by four surgeons (soon to be five). All patients are currently seen at 6 weeks, 1 year, 5 years and 10 years in a face-to-face clinic by a member of the multidisciplinary team – consultant, registrar or senior physiotherapist (ESP). This level of activity will generate 1740 follow up appointments each year for the next 10 years. This is going to increase because of a growing and ageing population. This is unsustainable and wasteful.

The current system has resulted in patients having to wait longer for clinic appointments, sometimes inappropriately and dangerously. This results often in poor patient experience and unnecessary generation of clerical work and contact that add nothing to patient care.

Our new system and processes will stop this while we increase capacity and decrease cost of delivery without compromising patient safety or quality of care for new and follow up patients.

What does your project aim to achieve?

Our project aims to

• Improve patient experience/satisfaction and outcomes
• Prevent waste through ensuring appropriate stream of follow up (face to face (F2F) with known consultant / team or non F2F (no clinical concerns) optimising added value of every patient contact / interaction
• Improve staff satisfaction through using a more efficient scheme

Benefits to Patients include, decreased need to travel and costs associated, decreased carbon emissions and follow up and care more locally.

Benefits to the Trust include, decreased need for already scarce clinic space and time, decreased staffing costs, decreased need for parking on site, increased direct clinical care time for surgeons to do operations, and reduced carbon footprint related to follow up visits.

Measures will include: Patient & staff satisfaction, no. of non F2F and F2F follow up appointments, number of clinic appointments freed for new patients, emergency admissions for revision surgery or periprosthetic fractures.

How will the project be delivered?

Through a triad of:

• Online patient outcome questionnaire
• X-Ray
• Trends associated with sequential outcomes from questionnaire and x-ray

We aim to deliver this through an interactive digital platform compatible and directly linked into current hospital platforms.

The team has experience in delivering successful improvement projects previously, we will use methods learned.

The project team comprises of a multidisciplinary team of:

– Patient involvement in co-designing the future of the service

– Orthopaedic surgeon (member of the British Hip Society Executive Committee)

– Physiotherapy Lead

– Improvement Advisor / Q Member / Data Specialist

– Orthopaedic Service Manager

– Orthopaedic Clinical Service Lead (previous successful Improvement project experience)

Risks

Omitting patients – suitable digital technology required to ensure all patients are tracked

Inconsistency – ensure standardized pathways, binary questionnaires and radiology assessment checklists for all patients

What and how is your project going to share learning throughout?

This project will use improvement methodology including PDSA cycles to test and learn. It will be shared internally via Improvement Grand Round presentations, Newsletters and by word of mouth and externally via Social Media, presentations at meetings, GIRFT reports and in journals. The model should be easy to replicate and therefore implement in other departments and trusts facing similar challenges.

We plan to do regular blogs with the progress of this work.

We intend to publish an article outlining our approach and results in the BMJ Open Quality Journal.

We will share our project at appropriate conferences and meetings nationally.

We will be active on social media throughout the project and encourage participation from outside of the current team from Q members and wider.