Orthopaedic OPD discharges Audit

Dr Ramy Sherif

BACKGROUND:-
Traditionally, all non-operative limb fractures seen at A&E are referred to
a Fracture Clinic within a few days of injury.

• The majority are benign injuries which could be treated with advice,
together with a removable splint to promote self-care.

• many of these injuries are treated with plaster which requires further
appointments, and for the lower limb, use of crutches.

** This frequently delays return to work and regaining normal function.

Orthopaedic OPD has the highest rate of
patients’ flow to subspecialty OPD’s in Sohar
hospital.
G medicine
21%
G medicine
Other 11 Obs&Gyn
23%
Orthopedic
G surgery paediatric
6%
Obs&Gyn Ophthalmo
Ophthalmo 15% G surgery
7% Other 11
paediatric Orthopedic
13% 14%
 Why is this audit?
• Over booked fracture clinics – 10-20%
• Unacceptable delay for first fracture clinic appointment
• Inadequate time to examine patients
• Limited consultant input due to large numbers
• Inappropriate A & E referrals
• Inappropriate specialty clinic appointments
• Increasing complaints
• Lack of teaching time
• Poor staff experience
• Poor patient experience
 Audit topic
• Orthopaedic OPD discharge
Audit period :- october2015-december 2015
Report date :- 20 January 2016
Aim:-
To improve health care services presented by Orthopaedics' OPDs
Objectives:-
1. to decrease waiting list from 2 months to 1 month
2. To discharge 10% of cases either home or the peripheral clinics
3. Better trainee experience, teaching and support
4. More time with patients
Literature review& Audit standards
criteria standard evidence

OPD Discharge 10% Khoula Hospital protocol

CONCLUSIONS :-
*Re-reviewing patients has a significant impact on the
number of patients seen in future clinics and, therefore,
the time that can be devoted to each patient, individual
consultant workload and teaching of junior staff.

*Discharge protocols are recommended for common

trauma conditions to standardise the process.
Method & Design:-
The audit has been conducted to establish if the
action plan had improved practice and involved a
retrospective cases’ note review of 263 electronic
patient records out of a whole patients number
of 5654 in the last three months of 2015.
** manual review of every case had to be done
to differentiate between system discharge and
staff discharge.
 Data analysis
October 2015
Total number of the patients is 1803 patient
Total number of discharges is 75 patient
Actual number of staff discharge 20 patient

8 7
4 4 4
4
1
0
Dr khalid Dr Ala Dr Shawer Dr shakil Dr Ramy
November 2015
Total number of the patients is 1992 patient
Total number of discharges is 102 patient
Actual number of staff discharge 62 patient
11 13 13
10 7 8
3 1 3 1 3
0
December 2015
Total number of the patients is 1859 patient
Total number of discharges is 86 patient
Actual number of staff discharge 58 patient

30
21
20
11
10 4 6 6 3
2 1 2 2
0

Final Results
Feed back findings:-

• The results of the clinical audit were fed back to the team.
• The report of the audit was circulated in the department morning meeting and to
orthopedic department’s seniors .
Areas for improvement :-
*Orthopedic department is doing a great effort to explain the discharge and assure the
patients.

*Discharges have been rising up by time and have a good feedback over appointment
waiting time.

* OPD waiting time has been markedly affected and it is acceptable to some OPDs
Appointment waiting time :-

60
52
50
40 37
30
30 25
20 18 16 normal
13 14 15 15
9 9 9 overbooking
10 42
0
6 1 2
in
e i c 17 18 19 rt
1 16 sp li n m m m p o
om om e c o o o re
ro ro ur ro ro ro
act
fr
 *Recommendations:-
1-More orientation is needed for safe discharge.

2-Patient with chronic diseases should be oriented more that the

same medication is available in local health centers.

3- A lot of time had been consumed to finalize the audit and this
can be saved if there is OPD discharge module in AlSHIFA3PLUS
system.
4- Leaflets for most common cases should be encouraged to
assure patients.
Common cases for discharge
 Review Standard & Reaudit
• Standards are to be modified so that they can
be operationalized more easily & consistently.
(e.g. trauma discharge ,, chronic diseases
discharge)

• It was decided that this clinical audit should be

conducted every three months.
 Future plan
• Next Reaudit will be conducted on next June
and reviewing the first six months of 2016.

• Special Reaudit will be targeting the main first

diagnosis in the hospital for low back pain and
framing the discharge plan.
References
1. Jennings AG, Saeed K, Dolan S, Wise DI. Impact of the introduction of a daily
trauma list on out-of-hours operating. Ann R Coll Surg Engl 1999; 81: 65–8.
2. Partington PF, Ions GK. A five consultant orthopaedic rota, to allow a
consultant
led trauma service. Ann R Coll Surg Engl 1996; 78 (Suppl): 21–2.
3. Lo S, Fergie N, Walker C, Narula AA. What is the impact of consultant
supervision
on outpatient follow up rate? Clin Otolaryngol 2004; 29: 119–23.
4. Lloyd J, Dillon D, Hariharan K. Outpatient clinics. Down the line. Health Serv J
2003; 113: 22–3.
5. Gammage M, Taylor M. Hospitals. Trauma without crisis. Health Serv J 1998;
108: 24–5.