Sharing policies between divisions (2023)

Type of publication:Service improvement case study

Author(s):*Helen Ford, *Rachel North, *Tina Dodd, *Nina Sinclair, *Gemma Styles

Citation:SaTH Improvement Hub, July 2023

Abstract:To improve the communication of polices that need to be shared between divisions as evidence by a written and agreed process by June 2023.

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Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts are effective in the treatment of chronic Achilles tendon ruptures - a systematic review (2023)

Type of publication:Journal article

Author(s):Nilsson N.; Stensota I.; Nilsson Helander K.; Brorsson A.; *Carmont M.R.; Concaro S.

Citation:BMC Musculoskeletal Disorders. 24(1) (no pagination), 2023. Article Number: 951. Date of Publication: December 2023.

Abstract:Introduction: A chronic Achilles tendon rupture (ATR) is defined as an ATR that has been left untreated for more than four weeks following rupture. This systematic review aims to summarize the outcomes of chronic ATR treated using either a gastrocnemius aponeurosis flap or semitendinosus tendon graft. Method(s): A systematic search was conducted in three databases (PubMed, Scopus and Cochrane), for studies describing outcomes after surgical treatment of chronic ATR using gastrocnemius aponeurosis flaps or semitendinosus tendon grafts with more than 10 patients included. The studies were assessed for quality and risk of bias using the Methodological Items used to assess risk of bias in Non-Randomized Studies (MINORS). Result(s): Out of the 818 studies identified with the initial search, a total of 36 studies with 763 individual patients were included in this systematic review. Gastrocnemius aponeurosis flap was used in 21 and semitendinosus tendon graft was used in 13 of the studies. The mean (SD) postoperative Achilles tendon Total Rupture Score (ATRS) for patients treated with a gastrocnemius aponeurosis flap was 83 (14) points and the mean (SD) American Orthopaedic Foot and Ankle Score (AOFAS) was 96 (1.7) points compared with ATRS 88 (6.9) points and AOFAS 92 (5.6) points for patients treated with a semitendinosus tendon graft. The included studies generally had low-quality according to MINORS, with a median of 8 (range 2-13) for all studies. Conclusion(s): Both gastrocnemius aponeurosis flaps and semitendinosus tendon grafts give acceptable results with minimal complications and are valid methods for treating chronic ATR. The main difference is more wound healing complications in patients treated with a gastrocnemius aponeurosis flap and more sural nerve injuries in patients treated with a semitendinosus grafts. The current literature on the subject is of mainly low quality and the absence of a patient-related outcome measure validated for chronic ATR makes comparisons between studies difficult. Level of Evidence: Level IV.

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Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes-Patient Operative Delays (ORTHOPOD) study (2023)

Type of publication:Journal article

Author(s):Ahmed H.E.; Baldock T.; Wei N.; Walshaw T.; Walker R.; Trompeter A.; Scott S.; Eardley W.G.P.; Stevenson I.; Yoong A.; Rankin I.; Dixon J.; Lim J.W.; Sattar M.; McDonald S.; Davies H.; Jones L.; Nolan M.; McGinty R.; Stevenson H.; Bowe D.; Sim F.; Vun J.; Strain R.; Giannoudis V.; Talbot C.; Gunn C.; Le H.P.D.; Bradley M.; Lloyd W.; Hanratty B.; Lim Y.; Brookes-Fazakerley S.; Varasteh A.; Francis J.; Choudhry N.; Malik S.; Vats A.; Evans A.; Garner M.; Zbaeda M.; Diamond O.; Baker G.; Napier R.; Guy S.; McCauley G.; King S.; Edwards G.; Lin B.; Davoudi K.; Haines S.; Raghuvanshi M.; Buddhdev P.; Karam E.; Nimmyel E.; Ekanem G.; Lateef R.; Jayadeep J.S.; Crowther I.; Mazur K.; Hafiz N.; Khan U.; Chettiar K.; Ibrahim A.; Gopal P.; Tse S.; Lakshmipathy R.; Towse C.; Al-Musawi H.; Walmsley M.; Aspinall W.; Metcalfe J.; Moosa A.; Crome G.; Abdelmonem M.; Lakpriya S.; Hawkins A.; Waugh D.; Kennedy M.; Elsagheir M.; Kieffer W.; Oyekan A.; Collis J.; Raad M.; Raut P.; Baker M.; Gorvett A.; Gleeson H.; Fahmy J.; Walters S.; Tinning C.; Chaturvedi A.; Russell H.; Alsawada O.; Sinnerton R.; Warwick C.; Dimascio L.; Ha T.T.; King T.; Engelke D.; Chan M.; Gopireddy R.; Deo S.; Vasarhelyi F.; Jhaj J.; Dogramatzis K.; McCartney S.; Ardolino T.; Fraig H.; Hiller-Smith R.; Haughton B.; Greenwood H.; Stephenson N.; Chong Y.; Sleat G.; Saedi F.; Gouda J.; Ravi S.M.; Henari S.; Imam S.; Howell C.; Theobald E.; Wright J.; Cormack J.; Borja K.; Wood S.; Khatri A.; Bretherton C.; Tunstall C.; Lowery K.; Holmes B.; Nichols J.; Bashabayev B.; Wildin C.; Sofat R.; Thiagarajan A.; Abdelghafour K.; Nicholl J.; Abdulhameed A.; Duke K.; Maling L.; McCann M.; Masud S.; Marshman J.; Moreau J.; Cheema K.; Rageeb P.M.; Mirza Y.; Kelly A.; Hassan A.; Christie A.; Davies A.; Tang C.; Frostick R.; Pemmaraju G.; Handford C.; Chauhan G.; Dong H.; Choudri M.J.; Loveday D.; Bawa A.; Baldwick C.; Roberton A.; Burden E.; Nagi S.; Johnson-Lynn S.; Guiot L.; Kostusiak M.; Appleyard T.; Mundy G.; Basha A.; Abdeen B.; Robertson-Smith B.; Hussainy H.A.; Reed M.; Jamalfar A.; Flintoft E.; McGovern J.; Alcock L.; Koziara M.; Ollivere B.; Zheng A.; Atia F.; Goff T.; Slade H.; Teoh K.; Shah N.; Al-Obaedi O.; Jamal B.; Bell S.; Macey A.; Brown C.; Simpson C.; Alho R.; Wilson V.; Lewis C.; Blyth D.; Chapman L.; Woods L.; Katmeh R.; Pasapula C.; Youssef H.; Tan J.; Famure S.; Grazette A.; Lloyd A.; Beaven A.; Jackowski A.; Piper D.; Lotfi N.; Chakravarthy J.; Elzawahry A.; Trew C.; Neo C.; Elamin-Ahmed H.; Ashwood N.; Wembridge K.; Eyre-Brook A.; Greaves A.; Watts A.; Stedman T.; Ker A.; Wong L.S.; Fullarton M.; Phelan S.; Choudry Q.; Qureshi A.; Moulton L.; Cadwallader C.; Jenvey C.; Aqeel A.; Francis D.; Simpson R.; Phillips J.; Matthews E.; Thomas E.; Williams M.; Jones R.; White T.; Ketchen D.; Bell K.; Swain K.; Chitre A.; Lum J.; Syam K.; Dupley L.; O'Brien S.; *Ford D.; *Chapman T.; *Zahra W.; Guryel E.; McLean E.; Dhaliwal K.; Regan N.; Berstock J.; Deano K.; Donovan R.; Blythe A.; Salmon J.; Craig J.; Hickland P.; Matthews S.; Brown W.; Borland S.; Aminat A.; Stamp G.; Zaheen H.; Jaibaji M.; Egglestone A.; Sampalli S.R.; Goodier H.; Gibb J.; Islam S.; Ranaboldo T.; Theivendran K.; Bond G.; Richards J.; Sanghera R.; Robinson K.; Fong A.; Tsang B.; Dalgleish J.; McGregor-Riley J.; Barkley S.; Eardley W.; Elhassan A.; Tyas B.; Chandler H.; McVie J.; Negus O.; Ravi K.; Qazzaz L.; Mohamed M.; Sivayoganthan S.; Poole W.; Slade G.; Beaumont H.; Beaumont O.; Taha R.; Lever C.; Sood A.; Moss M.; Khatir M.; Jeffers A.; Brookes C.; Dadabhoy M.; Bhattacharya R.; Singh A.; Beer A.; Hodgson H.; Rahman K.; Barter R.; Mackinnon T.; Frasquet-Garcia A.; Aldarragi A.; Warner C.; Pantelides C.; Attwood J.; Al-Uzri M.; Qaoud Q.A.; Green S.; Osborne A.; Griffiths A.; Emmerson B.; Slater D.; Altahoo H.; Scott H.; Rowland D.; O'Donnell J.; Edwards T.; Hafez A.; Khan B.; Crane E.; Axenciuc R.; Al-Habsi R.; McAlinden G.; Sterne J.; Wong M.L.; Patil S.; Ridha A.; Rasidovic D.; Searle H.; Choudhry J.; Farhan-Alanie M.M.; Tanagho A.; Sharma S.; Thomas S.; Smith B.; McMullan M.; Winstanley R.; Mirza S.; Hamlin K.; Elgayar L.; Larsen M.P.; Eissa M.; Stevens S.; Hopper G.P.; Fang Soh T.C.; Doorgakant A.; Yogeswaran A.; Myatt D.; Mahon J.; Ward N.; Reid S.; Deierl K.; Brogan D.; Little M.; Deakin S.; Baines E.; Jones G.; Boulton H.; Douglas T.; Jeyaseelan L.; Abdale A.; Islam A.; Atkinson K.V.; Mohamedfaris K.; Mmerem K.; Jamal S.; Wharton D.; Rana A.; McAllister R.; Sasi S.; Thomas T.; Pillai A.; Flaherty D.; Khan M.; Akkena S.; Shandala Y.; Lankester B.; Hainsworth L.

Citation:Injury. 54(12) (no pagination), 2023. Article Number: 111007. Date of Publication: December 2023. [epub ahead of print]

Abstract:Introduction: Current practice following injury within the United Kingdom is to receive surgery, at the institution of first contact regardless of ability to provide timely intervention and inconsiderate of neighbouring hospital resource and capacity. This can lead to a mismatch of demand and capacity, delayed surgery and stress within hospital systems, particularly with regards to elective services. We demonstrate through a multicentre, multinational study, the impact of this at scale. Methodology: ORTHOPOD data collection period was between 22/08/2022 and 16/10/2022 and consisted of two arms. Arm 1 captured orthopaedic trauma caseload and capacity in terms of sessions available per centre and patients awaiting surgery per centre per given week. Arm 2 recorded patient and injury demographics, time of decision making, outpatient and inpatient timeframes as well as time to surgery. Hand and spine cases were excluded. For this regional comparison, regional trauma networks with a minimum of four centres enroled onto the ORTHOPOD study were exclusively analysed. Result(s): Following analysis of 11,202 patient episodes across 30 hospitals we found no movement of any patient between hospitals to enable prompt surgery. There is no current system to move patients, between regional centres despite clear discrepancies in workload per capacity across the United Kingdom. Many patients wait for days for surgery when simple transfer to a neighbouring hospital (within 10 miles in many instances) would result in prompt care within national guidelines. Conclusion(s): Most trauma patients in the United Kingdom are managed exclusively at the place of first presentation, with no consideration of alternative pathways to local hospitals that may, at that time, offer increased operative capacity and a shorter waiting time. There is no oversight of trauma workload per capacity at neighbouring hospitals within a regional trauma network. This leads to a marked disparity in waiting time to surgery, and subsequently it can be inferred but not proven, poorer patient experience and outcomes. This inevitably leads to a strain on the overall trauma system and across several centres can impact on elective surgery recovery. We propose the consideration of inter-regional network collaboration, aligned with the Major Trauma System.

Healthcare professionals' views to inform revision of the BAPM newborn early warning trigger and track system (2023)

Type of publication:Journal article

Author(s):Ojha S.; MacAllister K.; Abdula S.; Madar J.; Rackham O.; *Tyler W.

Citation:Archives of Disease in Childhood: Fetal and Neonatal Edition. 108(1) (pp F92-F93), 2023. Date of Publication: January 2023.

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