SURGERY
specific level, which means that practice rarely changes despite best practice and an increasing body of research knowledge. GIRFT has decided that an audit of patients with SSIs should be undertaken to examine the care of patients peri- and postoperatively. Data will be collected prospectively and retrospectively by volunteers (doctors in training). The prospective data is being collected from May 2017 to October 2017 and retrospectively from November 2016 to May 2017. The key intention is for clinicians to examine SSIs per surgical team and decide whether key aspects of best practice are being followed.
This audit based initiative will encourage the scrutiny of SSIs and will not interfere with the surveillance data which is regularly collected and submitted to Public Health England.
Outcomes from GIRFT
It is too early to give more than a passing glance at the outcome data although there is to be a study on the original orthopaedic project, starting later this year. There are already rumours of high value cash savings being bandied about, and it may well be true as Trusts re-negotiate the cost of their orthopaedic implants (cost of plates, range £22-£1,583; cost of rods £72-£1,066; cost of cages and spacers £22- £1,583), their post –operative care costs which vary from £531- £2,803 and the cost of loan kit sent into the Trust by the medical device
companies, range of costs (200k average - £760 max per site). The claims made by the orthopaedic project are significant. They cite improved patient outcomes, improved patient experience and safety, re-empowered clinicians, increased functional bed capacity, a reduced flow of work to independent providers, significant taxpayer savings and an overall improvement in Trust balance sheets. They also identify reduced complications and re-admissions, reduced length of stay, better directed care pathways, a more productive workforce and reduction in locum costs as well as a reduction in procurement and loan kit costs.
Conclusion
Based on the above outcomes it is hard to see why this data is not being shouted from the hill tops - as after so many years when
such small marginal costs have been saved from some specialty budgets, these are possibly massive.
They are not without challenges, these local projects. Primary care, social care difficulties, reduced hospital staffing across teams including trainee doctor hours, reduced beds and even scarcer resources year on year reduce the opportunities for these actions to work but if they can, and they release cash and add quality and value to a patients experience – bring them on. We await the results with hope and patience.
CSJ References
1. Department of Health England. Next Steps on the Five Year Forward View. March 2017 accessed at
https://www.england.nhs.uk/wp- content/uploads/2017/03/NEXT-STEPS-ON-THE- NHS-FIVE-YEAR-FORWARD-VIEW.pdf
2. NHS Atlases of Variation in health and care accessed at
https://improvement.nhs.uk/ resources/atlas-variation-health-and-care/ and
http://fingertips.phe.org.uk/profile/atlas-of-variation
3. British Orthopaedic Association. 2015 A national review of adult, elective orthopaedic services in England. Getting it Right First Time. Accessed at
https://www.boa.ac.uk/wp- content/uploads/2015/03/GIRFT-National-Report- Mar15.pdf
4. Kings Fund. Tackling variations in clinical care. Assessing the Getting it right first time programme. June 2017, Nicholas Timmins. Accessed at
https://www.kingsfund.org.uk/publications/tackling- variations-clinical-care
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