A retrospective audit of the timescales involved in the diagnosis and management of suspected Achilles tendon ruptures at a single National Health Service trust: A quality service improvement and redesign project

Abstract

Introduction: The Achilles tendon is the most frequently ruptured tendon. Prompt diagnosis of this injury ensures optimal management decisions are instituted early ensuring the best outcome and patient experience, at minimal cost to the United Kingdom National Health Service. Despite this, regional and national variations to diagnosis and management exist, with anecdotal evidence of inefficiencies in the local patient pathway. To explore this further, a retrospective departmental audit of timescales from presentation to ultrasound diagnosis and definitive treatment decision was undertaken.

Methods: All suspected Achilles tendon ruptures in 2018 were identified through electronic and written patient records, and information on timescales involved in the diagnosis and management of each compiled. Descriptive statistics were used to map each step of the pathway and timescales involved, with performance assessed against local departmental standards and the Swansea Morriston Achilles Rupture Treatment (SMART) protocol.

Results: In total, 119 patients were identified, of which 113 received an ultrasound examination. Local departmental standards were met in the majority of cases, with 78% (n = 88) diagnosed by ultrasound within one week of the request and 83% (n = 91) given a treatment decision within two weeks of presentation. However, this was suboptimal when compared with timeframes utilised for developing the SMART protocol, with only 7% (n = 8) scanned within 48 hours of presentation.

Conclusions: Key areas of the patient pathway were identified for quality service improvement and redesign, with multidisciplinary discussion resulting in the development of a revised patient pathway which expedites diagnosis and treatment for these injuries.

Keywords: Swansea Morriston Achilles Rupture Treatment protocol; Treatment; quality service improvement and redesign; ultrasound.

Figure 1.

Time to USS following receipt of request.

Figure 2.

(a) Number of USS performed within seven days of receiving the request (current local standard). (b) Number of USS performed on the same day request was received or next working day. (c) Number of scans performed on the same day as initial injury presentation or next working day (as per SMART protocol).

Figure 3.

USS diagnoses of the 113 patients scanned.

Figure 4.

Number of days from first trust presentation to USS diagnosis for the 113 patients scanned.

Figure 5.

Number of days between USS and orthopaedic review.

Figure 6.

Number of days between first trust presentation and definitive treatment decision for the 113 patients scanned.