Establish that the patient needs/wants surgery

Although this may seem self-evident, data from the Action On and Collaborative sites suggests that one in four patients added to the orthopaedic waiting list are removed without treatment.  This is wasting everyone's time, including the patient's. The two main causes are that the patient is unsure that they want surgery or that they are unfit for surgery. Approaches that may help include:

  • clear communication with GP's around the criteria for surgery - use of a structured assessment tool may be helpful
  • checking that patients will actually consider an operation before referral
  • early health assessment, preferably before a patient is added to the waiting list
  • education classes to prepare the patient for surgery
  • having an honest discussion with the patient regarding realistic expectations from a procedure

How to do this in scenario generator

OUTCOME
CHANGE
Criteria for surgery, checking willingness, risk assessment Reduce percentage of new referrals from primary care.  Increase the percentage classified Not Fit and Not Willing.  This will increase self care percentage but also lead to a small increase in private care.  Adjust both self care and private care routing percentages to model different impacts of increasing numbers being identified as unfit or unwilling.
Health assessments and peer education Increase the percentage routing through health improvement and medication or direct referral to alternatives eg therapy, GPSI and PCPI.  Increase self care percentage Decrease the complication and readmission rates to compensate, including reducing the number of patients who smoke, undertake low levels of physical exercise or who are over 30 BMI Review the percentage requiring a preoperative assessment Reducing complication rates will reduce length of stay but consider further reductions in length of stay reflecting patients being admitted in better health, also consider reducing the cancellation rate for operations or clinical reasons