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. 2022 Jun 16;12(6):e058316.
doi: 10.1136/bmjopen-2021-058316.

Mixed methods evaluation of the Getting it Right First Time programme in elective orthopaedic surgery in England: an analysis from the National Joint Registry and Hospital Episode Statistics

Helen Barratt  1 , Andrew Hutchings  2 , Elena Pizzo  1 , Fiona Aspinal  1 , Sarah Jasim  3 , Rafael Gafoor  1 , Jean Ledger  1 , Raj Mehta  1 , James Mason  4 , Peter Martin  1 , Naomi J Fulop  1 , Stephen Morris  5 , Rosalind Raine  1
Affiliations

Mixed methods evaluation of the Getting it Right First Time programme in elective orthopaedic surgery in England: an analysis from the National Joint Registry and Hospital Episode Statistics

Helen Barratt et al. BMJ Open. .

Abstract

Objective: To evaluate the impact of the 'Getting it Right First Time' (GIRFT) national improvement programme in orthopaedics, which started in 2012.

Design: Mixed-methods study comprising statistical analysis of linked national datasets (National Joint Registry; Hospital Episode Statistics; Patient-Reported Outcomes); economic analysis and qualitative case studies in six National Health Service (NHS) Trusts.

Setting: NHS elective orthopaedic surgery in England.

Participants: 736 088 patients who underwent primary hip or knee replacement at 126 NHS Trusts between 1 April 2009 and 31 March 2018, plus 50 NHS staff.

Intervention: Improvement bundle including 'deep dive' visits by senior clinician to NHS Trusts, informed by bespoke set of routine performance data, to discuss how improvements could be made locally.

Main outcome measures: Number of procedures conducted by low volume surgeons; use of uncemented hip implants in patients >65; arthroscopy in year prior to knee replacement; hospital length of stay; emergency readmissions within 30 days; revision surgery within 1 year; health-related quality of life and functional status.

Results: National trends demonstrated substantial improvements beginning prior to GIRFT. Between 2012 and 2018, there were reductions in procedures by low volume surgeons (ORs (95% CI) hips 0.58 (0.53 to 0.63), knees 0.77 (0.72 to 0.83)); uncemented hip prostheses in >65 s (OR 0.56 (0.51 to 0.61)); knee arthroscopies before surgery (OR 0.48 (0.41 to 0.56)) and mean length of stay (hips -0.90 (-1.00 to -0.81), knees -0.74 days (-0.82 to -0.66)). The additional impact of visits was mixed and comprised an overall economic saving of £431 848 between 2012 and 2018, but this was offset by the costs of the visits. Staff reported that GIRFT's influence ranged from procurement changes to improved regional collaboration.

Conclusion: Nationally, we found substantial improvements in care, but the specific contribution of GIRFT cannot be reliably estimated due to other concurrent initiatives. Our approach enabled additional analysis of the discrete impact of GIRFT visits.

Keywords: hip; knee; surgery.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/ coi_disclosure.pdf and declare: HB, AH, EP, FA, SJ, RG, JL and RR are funded in full or in part by the National Institute for Health Research ARC North Thames. RR and NJF are NIHR Senior Investigators; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
The economic components of GIRFT orthopaedic evaluation. GIRFT, Getting it Right First Time; HES, Hospital Episode Statistics; HRGs, Healthcare Resource Groups; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; PROMs, patient-reported outcomes measures; QALYs, quality-adjusted life-years.
Figure 2
Figure 2
Study population—total hip replacement patients. Patient-reported outcomes measures (PROMs) data collected from April 2009 for consenting patients only. GIRFT, Getting it Right First Time; NHS, National Health Service.
Figure 3
Figure 3
Study population—total knee replacement patients. Patient-reported outcomes measures (PROMs) data collected from April 2009 for consenting patients only. GIRFT, Getting it Right First Time; HES, Hospital Episode Statistics; NHS, National Health Service; NJR, National Joint Registry.
Figure 4
Figure 4
Trends in process and outcome measures for primary hip replacements (2009/2010–2017/2018). OHKS, Oxford Hip/Knee Score.
Figure 5
Figure 5
Trends in process and outcome measures for primary knee replacements (2009/2010–2017/2018). OHKS, Oxford Hip/Knee Score.
Figure 6
Figure 6
Summary of impacts attributed to GIRFT orthopaedic visits at six case-study site. GIRFT, Getting it Right First Time.
See this image and copyright information in PMC

References

    1. Briggs T. Getting it Right First Time: improving the quality of orthopaedic care within the National Health Service in England. London: British Orthopaedic Association, 2012.
    1. Briggs T. Getting it Right First Time: a national review of adult elective orthopaedic services in England. London: British Orthopaedic Association, 2015.
    1. Resar R, Pronovost P, Haraden C, et al. . Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 2005;31:243–8. 10.1016/S1553-7250(05)31031-2 - DOI - PubMed
    1. Maggard-Gibbons M. The use of report cards and outcome measurements to improve the safety of surgical care: the American college of surgeons national surgical quality improvement program. BMJ Qual Saf 2014;23:589–99. 10.1136/bmjqs-2013-002223 - DOI - PMC - PubMed
    1. Peden CJ, Moonesinghe SR. Measurement for improvement in anaesthesia and intensive care. Br J Anaesth 2016;117:145–8. 10.1093/bja/aew105 - DOI - PubMed

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