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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.

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cam.issuedOnline2022-06-16
dc.contributor.authorBarratt, Helen
dc.contributor.authorHutchings, Andrew
dc.contributor.authorPizzo, Elena
dc.contributor.authorAspinal, Fiona
dc.contributor.authorJasim, Sarah
dc.contributor.authorGafoor, Rafael
dc.contributor.authorLedger, Jean
dc.contributor.authorMehta, Raj
dc.contributor.authorMason, James
dc.contributor.authorMartin, Peter
dc.contributor.authorFulop, Naomi J
dc.contributor.authorMorris, Stephen
dc.contributor.authorRaine, Rosalind
dc.contributor.orcidBarratt, Helen [0000-0002-1387-137X]
dc.contributor.orcidHutchings, Andrew [0000-0003-0215-9923]
dc.contributor.orcidPizzo, Elena [0000-0003-0790-7505]
dc.contributor.orcidAspinal, Fiona [0000-0003-3170-7570]
dc.contributor.orcidJasim, Sarah [0000-0003-3940-6350]
dc.contributor.orcidGafoor, Rafael [0000-0001-6865-1270]
dc.contributor.orcidLedger, Jean [0000-0003-2523-7971]
dc.contributor.orcidMehta, Raj [0000-0002-4003-530X]
dc.contributor.orcidMason, James [0000-0001-9210-4082]
dc.contributor.orcidMartin, Peter [0000-0003-4638-0638]
dc.contributor.orcidFulop, Naomi J [0000-0001-5306-6140]
dc.contributor.orcidMorris, Stephen [0000-0002-5828-3563]
dc.contributor.orcidRaine, Rosalind [0000-0003-0904-749X]
dc.date.accessioned2022-06-29T19:42:33Z
dc.date.available2022-06-29T19:42:33Z
dc.date.issued2022-06-16
dc.date.submitted2021-10-12
dc.date.updated2022-06-29T19:42:33Z
dc.description.abstractOBJECTIVE: 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.
dc.identifier.doi10.17863/CAM.85852
dc.identifier.eissn2044-6055
dc.identifier.issn2044-6055
dc.identifier.otherbmjopen-2021-058316
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/338439
dc.languageen
dc.language.isoeng
dc.publisherBMJ
dc.publisher.urlhttp://dx.doi.org/10.1136/bmjopen-2021-058316
dc.subjecthip
dc.subjectknee
dc.subjectsurgery
dc.subjectArthroplasty, Replacement, Knee
dc.subjectEngland
dc.subjectHospitals
dc.subjectHumans
dc.subjectOrthopedics
dc.subjectQuality of Life
dc.subjectRegistries
dc.subjectState Medicine
dc.titleMixed 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.
dc.typeArticle
dcterms.dateAccepted2022-05-01
prism.issueIdentifier6
prism.publicationNameBMJ Open
prism.volume12
pubs.funder-project-idNational Institute for Health Research (ARC North Thames (award/grant number is not applic)
rioxxterms.freetoread.startdate2022-06-16
rioxxterms.licenseref.startdate2022-06-16
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1136/bmjopen-2021-058316

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