Optimising your recovery

Leader(s)Lisa Hacker, Avril Sharman and Lauren Hacker
LocationOrthopaedic Outpatients Department, The Royal Bournemouth Hospital
DurationNovember 2016-November 2018
Received for PublicationFebruary 2019

Avril Sharman, Lesley Owen-Gray, Christopher Blainey, Belinda Hewett, Sarah Pillinger and Lisa Hacker

The Orthopaedic Outpatients Department within the Royal Bournemouth County Hospital (RBCH) in Dorset manages orthopaedic patients from a large demographic, across the counties of Hampshire and Dorset and works collaboratively with the elective inpatients Orthopaedic Unit at the RBCH.

Patients and service users visit our department for a variety of appointments, including consultant review, pre-operative assessment, wound clinics, therapy review, plaster room services and post operative check-ups. Patients can attend numerous times depending on their care pathway. In our nurse led clinics, we see post operative patients (depending on a set criteria) regarding wound management.  Telephone reviews are also carried out for patients who require specific follow up. Nurses work autonomously within these agreed responsibilities and refer patients or discharge them from our services as appropriate. The department sees on average 700 patients every week across all clinics. In addition, to manage increased demand for the service, we now run ad hoc twilight and weekend sessions.

It was discovered that during November 2015, there were 75 theatre slots cancelled, either on the day or the day before surgery, which couldn’t be refilled at such short notice. Financially, this equated to £36,000 for every 6 patients who were having major orthopaedic procedures, which if saved would be the equivalent of an experienced full time staff nurse for a year.

The reasons for cancellations varied from patient to patient with some simply forgetting the date. However another reason was the length of time between the final outpatients visit and the surgery date; our outpatients service is predominantly ‘a one stop service’ and the time between listing for surgery and the operation date could be up to 10 weeks. During this time, vital information can be lost or forgotten meaning surgery cannot go ahead. The significance is that patients often make pre and post operative plans which would then be wasted, not to mention the stress, disappointment and financial upset cancellations caused.

The aim of this project was to improve the patient journey and to reduce the number of wasted/un-used theatre slots.

This project was supported by Patients First, a partnership programme with the Burdett Trust for Nursing.

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