News / Right first time expansion underway (HFMA 2016)

09 December 2016

Login to access this content

The Getting it right first time programme has already highlighted significant variation in orthopaedic practice across the country. Professor Tim Briggs, consultant orthopaedic surgeon and national director for clinical quality and efficiency who leads the programme, told the HFMA annual conference that it was already delivering improvements in orthopaedic practice and value. briggs hfma2016

A report on national variation was followed up with individual site visits, involving peer review of the data. ‘What GIRFT told me after the visits was that the variation out there is unbelievable,’ he said. This variation ranged from different admission and treatment rates to major differences in the approaches taken. It also exposed wide variation in the volumes of procedures undertaken with some sites and surgeons undertaking very low volumes of certain procedures. The prices paid for implants and equipment also varied significantly with little correlation between volume and the best prices.

‘There is a real possibility of making massive change doing things right to improve quality and tackle this variation,’ he added.

Early results include an increase in the number of patients discharged within four days of a knee replacement. There have been improvements in the proportion of cemented hip implants used for over 65s. This is backed by evidence for many cases and is significantly cheaper. Professor Briggs also said that new data showed a ‘reversal in the trend’ of growing orthopaedic related litigation costs.

But he said there were still trusts doing nothing with the orthopaedic data. However he said this was ‘no longer an option’ after the programme was effectively mandated and expanded by the Carter report on productivity.

Supporting this work, an orthopaedic dashboard has been developed as part of the broader model hospital initiative. This will show volumes by provider and consultant along with patient reported outcome data, infection rates, and revision rates. Data will be refreshed every six months, moving to three months, and shown alongside reference cost data.

In an expansion of the approach to other specialties, 11 national clinical leads have already been appointed and a further 19 are in the pipeline. Areas covered include spinal, general surgery, urology and renal, vascular, ear nose and throat, cardiothoracic, ophthalmology, oral and maxillofacial, neurosurgery, paediatric surgery, and obstetrics and gynaecology. Early work has underlined that there is variation across all specialties, both within organisations and across providers.