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Getting it right first time (GIRFT): A closed loop study of hip arthroplasty documentation in a trauma and
Jasmesh Sandhu1, Hemant Sharma1, Yamen Jabr2
1Trauma and Orthopaedic Department, University Hospital of North Tees, Stockton-on-Tees, TS19 8PE, UK.
Insights
Implementing an online template significantly improved hip arthroplasty documentation compliance with Getting It Right First Time (GIRFT) guidelines. This digital solution enhances operative note quality and adherence, benefiting surgeons and healthcare trusts.
Area of Science:
- Orthopaedic Surgery
- Surgical Documentation
- Quality Improvement in Healthcare
Background:
- Current hip arthroplasty documentation at University Hospital of North Tees exhibited suboptimal adherence to Getting It Right First Time (GIRFT) guidelines.
- A need was identified to enhance the quality and consistency of operative records for hip arthroplasty procedures.
Purpose of the Study:
- To assess baseline compliance with GIRFT hip arthroplasty guidance.
- To implement and evaluate an online operative hip arthroplasty template for improved documentation.
- To enhance the overall quality of hip arthroplasty documentation and adherence to GIRFT standards.
Main Methods:
- A team of 7 doctors conducted a retrospective audit of 20 hip arthroplasty operative records against 24 GIRFT criteria.
- An online, pre-populated hip arthroplasty template, aligned with GIRFT guidance, was integrated into the local 'Trackcare' system.
- A prospective audit of 20 operative notes was performed post-implementation to assess improvements.
Main Results:
- Initial retrospective review revealed poor compliance across the 24 GIRFT criteria, with a wide range (0%-100%).
- Following the implementation of the online template, prospective review demonstrated a significant improvement in compliance, ranging from 80% to 100% across all 24 criteria.
Conclusions:
- Identified documentation issues were largely modifiable through pragmatic solutions like the developed online template.
- The online hip arthroplasty template is user-friendly, achieves excellent compliance, and requires minimal completion time (6-7 minutes).
- This auditable system shows promise in reducing medico-legal risks for both individual surgeons and the healthcare trust.
Introduction:
The objectives of this study conducted in the University Hospital of North Tees, UK were to: (i) Identify if the current hip arthroplasty documentation met good compliance with the Getting It Right First Time (GIRFT) hip arthroplasty guidance (ii) Improve current documentation with a transition from hand-written notes to an online typed personalised operative hip arthroplasty template (iii) Improve the quality of documentation and adherence to GIRFT guidance in hip arthroplasty.
Methods:
We led a team of 7 doctors to review University Hospital of North Tees compliance against 24 criteria laid out by GIRFT. After examining 20 operative records retrospectively at random from a spread of orthopaedic consultants in the department, it was shown that there was poor compliance against GIRFT guidelines. We proposed a pragmatic solution of incorporating a pre-populated hip arthroplasty online template adhering to GIRFT guidance into our local 'Trackcare' system. Following that, we closed the audit loop by prospectively reviewing 20 operative notes.
Results:
Our initial results showed that poor compliance ranging 0%-100% over the 24 criteria. The findings of the 24 criteria with the online hip arthroplasty template in place showed a significant improvement between 80 and 100% compliance over the 24 criteria.
Conclusion:
The majority of the issues identified are modifiable risks factors which were amenable to some simple pragmatic solutions. A review of a single surgeon template has shown that it is simple to use, has excellent compliance (has pre-populated 24 criteria), takes 6-7 min to complete the operative notes, easily auditable and thus appears promising in minimising medico-legal claims for surgeons and the Trust.
