Our surgical inspections are designed to be patient centred. Our lay reviewers take the same journey that a patient takes through the orthopaedic and trauma surgery pathways. This involves following a patient from admission on the ward, to the theatre, and then back again from theatre onto the ward. Our lay reviewers can see the course of treatment through the patient’s eyes.
Our lay reviewers look at the fasting of patients in hospitals, to check patients are not being deprived of fluid for too long or too short a time. They also look at consenting practices, to check patients get the right information on their different treatment options, not just the operation.
Our surgical inspection is focussed on:
- Trauma surgery (emergency surgery on the bones)
- Elective orthopaedic surgery (planned surgery on the bones)
- The National Safety Standards for Invasive Procedures or NatSSIPs (Safety checks and processes during surgery).
We look at the care a patient receives before an operation (pre-operative phase), during the operation (intra operative phase) and after the operation (post operative phase).
Our surgical inspection involves more than just the operating theatre and looks at the pathway the patient takes.
- Surgical outpatient clinic – decision to proceed with surgery made here.
- Pre-assessment clinic – checking patient is fit for surgery happens here.
- Pre and post operative orthopaedic surgery ward - one emergency trauma ward and one elective orthopaedic surgery ward
- Operating theatres -in particular one trauma theatre and one elective orthopaedic theatre if possible.
Falls, fragility and fracture surgery
Patients who fall and break their bones can often be frail, elderly patients who have many associated medical conditions which need managing before and after emergency surgery. Consequently, the care they need to get better must be comprehensive and it involves more than, for example, just fixing a hip. Specialists from the care of the elderly services, pain services, physiotherapy service, social care service, trauma teams, anaesthetists and surgeons may all be involved along with the patient’s family and carers.
We look in particular at the frail elderly patients who need trauma surgery – on the ward and in theatres.
Elective (planned) orthopaedic (bone) surgery pathway
Patients who have planned operations on their bones, such as hip or knee replacements, should be appropriately prepared so that everything runs smoothly. Enhanced recovery is a modern evidence-based package of surgical care which allows people to recover quickly after major surgery. It is especially important for hip and knee surgery, to prevent patients staying longer, and also enables patients to deal both emotionally and physically with the stress of surgery better.
A comprehensive enhanced recovery pathway is expected for hip and knee surgery and we look at this pathway in particular.
National Safety Standards for Invasive Procedures (NatSSIPs)
The safety of patients is critical within theatres. Standards of care have recently been published, aimed at preventing wrong site operations, wrong implants and retained foreign bodies from operations.
The NatSSIPs also set out theatre workforce requirements, theatre list scheduling standards, procedural documentation and essential safety step standards. We will be looking at these standards closely from September 2017 when the implementation time frame passes for these standards.