NHS 'best practice' failingsNHS trusts falling short on orthopaedic care

15 November 2011

Doctor with hip xray

One in 10 Which? members who have had NHS hip or knee surgery did not think the process was well managed. 

And information shared exclusively with Which? shows that this could be wasting NHS money.

According to data from healthcare information provider Dr Foster, NHS trusts failing to meet seven best-practice standards for hip and knee replacements could be keeping patients in hospital for up to five days longer than needed. 

This, in turn, could increase hospital costs and the risk of infection.

Mixed results

Only a third of trusts phoned patients in the first 48 hours after they’d been discharged. 

A post-op phone call improves the patient experience and can help reduce re-admittance by heading off potential problems and anxieties.

A fifth of trusts failed to provide seven-day specialist physiotherapy meaning that patients admitted on a Friday might not be up and about as quickly as those  admitted earlier in the week, possibly adding to patient stays and NHS costs.

Best and worst performers

Among the best-performing NHS Foundation Trusts were The Royal Bournemouth and Christchurch Hospitals Trust, East Kent Hospitals Trust, Northumbria Healthcare and The Dudley Group of Hospitals.

However, South London Healthcare and St Georges Healthcare achieved only one of the seven standards.

A spokesperson from South London Healthcare NHS Trust said that it’s redesigning its three-site orthopaedic service so patients will be seen at an already successful one-site specialist centre.

Peter Kay of the British Orthopaedic Association said: ‘It’s disappointing that hospitals following the best-practice standards aren’t paid more to do so, as this would encourage hospitals in resourcing the best services for patients.’

The best-practice standards

The seven 'best practice' standards for elective (planned) hip and knee replacement surgery are:

  • Pre-surgery education - Classes which help relieve a patient's anxiety about their forthcoming operation, promote understanding, and manage the patient's expectations - for example, what pain to expect.
  • Admittance on day of surgery - Patients, who are generally well apart from the need for hip and knee surgery, are admitted on the day of surgery. This reduces the length of stay and therefore the risk of picking up an infection, but also allows the patient to be in the comfort of their own home for as long as possible before coming to hospital.
  • Standardised anaesthetic protocol - Anaesthetists in the hospital use the same type of anaesthetic, although this is tailored to the patient's need. This means that there is a good level of expertise for all staff, and this familiarity with the anaesthetic helps staff manage patients' pain and recovery.
  • Multidisciplinary recording of patient records - All professionals involved in the patient's care share one set of records including what is expected of the patient - for example, when they should be achieving certain goals. This means that all professionals are sharing information and this in turn reduces the risk of complications.
  • Seven-day-a-week orthopaedic physiotherapy service - Everyone has the same access to specialist physiotherapy and has the same experience, whether they are admitted on a Monday or just before the weekend.
  • Criteria-based discharge - A checklist that any professional treating the patient can potentially use to decide if the patient is well enough to go home if they have achieved their goals, and get them home as soon as they have. This helps reduce error in the discharge process, reducing risk to the patient.
  • Phoning the patient in the 48 hours after they leave hospital - This improves the patient experience and can help reduce re-admittance by heading off potential problems and anxieties.

More on this:

  • See more NHS results on the Dr Foster website
  • Find out about adapting your home for disability
  • Read about our hospital car parking campaign and what the situation is in hospitals local to you