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Good practice guide

Review of orthopaedic services

Self-assessment checklist for NHS boards

  • We have reviewed orthopaedic services to find more efficient ways of reducing waiting times, including:
    • reducing DNA rates.
    • reducing the rate of return appointments in outpatient clinics.
    • making better use of community-based services.
  • We are working with the Golden Jubilee National Hospital to better manage the referral of patients to this service.
  • We collect information on the cost and activity of orthopaedic work carried out privately and review this to establish whether care could be delivered more efficiently.
  • We review the reasons why patients are coded as being removed from the waiting list because treatment is no longer required and manage patients appropriately in line with new waiting lists guidance.
  • We are working with ISD to improve the accuracy of national information on cost and activity to ensure services are efficiently managed, including:
    • recording of procedures carried out in outpatient clinics
    • improving the quality and consistency of cost information reported in the Costs Book
    • improving tariff information to support accurate costing and financial planning for orthopaedic services.
  • We are working with NHS National Procurement to standardise the purchasing of surgical implants and equipment to ensure the best value for money based on cost and clinical effectiveness.
  • We are working with the Scottish Government to ensure benchmarking information on cost and activity is collected to allow comparison of efficiency with other NHS boards.
  • We monitor levels of day case and outpatient activity and look to deliver care in the most efficient and effective setting.
  • We are analysing activity, cost and quality indicators to develop a better understanding of productivity in order to deliver efficient services.
  • We monitor levels of activity for the whole orthopaedic team, including consultants and other doctor grades, nurses, physiotherapists and podiatrists, and take action where levels are low.
  • We review performance against quality indicators to ensure patient care is not adversely affected by service changes, such as an increase in activity.
  • We monitor performance against the time taken for hip fracture patients to have surgery to ensure medically fit patients are being operated on within 24 hours of safe operating time.
  • We have identified any gaps in access to rehabilitation for orthopaedic patients. We have an action plan in place to address these gaps.

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