Survey of the Use of Physician Review Websites in Patients Under Orthopaedic Care (Preprint)

BACKGROUND Physician-rating websites (PRWs) are rising in popularity as the healthcare sector focuses more on patient-centered value-based care delivery. Recent studies have reported that the vast majority of orthopaedic surgeons across subspecialties already have at least one rating or review on at least one PRW. However, there are few studies identifying patient-facing factors related to the knowledge and use of PRWs and the level of influence PRWs may have on patient decision-making. OBJECTIVE The objectives of this study are: 1) to determine the prevalence of PRW use by patients seeking orthopaedic care, 2) to identify the influence PRWs have on patient decision-making, and 3) to identify factors associated with knowledge and use of PRWs. METHODS Survey administration was performed at three outpatient orthopaedic multi-specialty. Patients were asked about demographic characteristics including age, sex, occupation, and education, as well as their familiarity with PRWs, use of PRWs, and how PRWs have influenced their decision to see their surgeon. RESULTS A total of 350 patients completed the survey. The majority were women (59%) and Caucasian (77%), and the mean age of the population was 58 years old (range 15-91). 155 patients (44%) reported being somewhat (31%) or very (13%) familiar with PRWs, and 195 patients (56%) reported no familiarity with PRWs. Patients most familiar with PRWs were between 45-64 years old (p = 0.02), women (p < 0.01), had graduate/professional degrees (p < 0.01), and seen by adult reconstruction surgeons (p = 0.02). Seventy-two percent of patients utilizing PRWs reported that PRWs had an impact on their decision to see their chosen provider, with 93% noting ratings and reviews as the most valuable information. CONCLUSIONS Many patients in this study were not familiar with PRWs and did not utilize PRWs prior to their visit. However, most patients who did consult PRWs reported that the ratings and reviews did have an impact in their decision to choose their orthopaedic specialist. As PRW use increases, factors that influence patient decision-making are important to understand for surgeons and administrators.

1403 Leadership and Teamwork in The Major Trauma Service – Implementation of A New Approach to Secondary Surveys

Aim Trauma Audit and Research Network (TARN) guidelines at a Major Trauma Centre in Northern Ireland state that all patients admitted with Major Trauma should have a secondary survey completed and documented within 24 hours of admission. Method All patients admitted with major trauma had their medical notes reviewed on discharge to look for evidence of a documented secondary survey. Two audit cycles were completed. The first from January 2018 to April 2018 (n = 38). Following a quality improvement project with specific interventions to improve compliance, including improved communication behaviours and the implementation of a revised trauma booklet, a second cycle was performed from October 2019 to January 2019 (n = 44) Results 58% of group 1 and 75% of group 2 had a documented secondary survey within 24 hours of admission. The interventions therefore resulted in an overall 17% increase in the number of secondary surveys completed within 24 hours. Patients admitted under Orthopaedic care had a significant improvement of 26% between cycles to 89% compliance. Cardiothoracics (33% to 40%), Neurosurgery (14% to 43%) and General Surgery (75% to 66%). Conclusions A quality improvement drive led by the Orthopaedic team involving the education of doctors, improving communication channels and the introduction of revised trauma documentation, resulted in a significant increase in the number of secondary surveys completed within 24 hours. Patients under the care of Orthopaedics were more likely to have a survey completed compared with other specialties. This highlights the need for more education and engagement of other specialities to increase compliance in secondary surveys.

Changing Trend in COVID 19 Pandemic, Orthopaedic Care, and Arthroplasty - A Prospective Study Conducted in Indira Gandhi Institute of Medical Sciences, an Apex Tertiary Centre of Bihar

BACKGROUND The novel corona virus pandemic has a profound impact on health services throughout the world, which reflected the changing guidelines of different health societies in different time zones. We tried first to ensure the safety of our patients and surgical staff. Patient care priorities based on strict evidence-based management of a particular case and also COVID-19-adjusted governmentimposed restriction during the crisis. We aim to study postoperative complication after arthroplasty and readmission rate and compared the same with the prepandemic era. We also address our strategies, concerns, and regulatory barriers due to government-imposed lockdown, during initial surge of pandemic and also when restrictions were lifted. This study is unique in the way that there is no such study from Bihar, a state of developing country with scarcity of specialized health services. METHODS In this prospective study done in Indira Gandhi Institute Of Medical Sciences, Patna, Bihar between 1st December 2019 to 31st January 2021 (14 months duration). We have selected a subset of those patient who were admitted for primary arthroplasty of hip during the pandemic after lock down, and compared those with patient those underwent similar operative management before the lockdown period. RESULTS There was no significant difference in postoperative complication and readmission rate when compared with the pre-pandemic era. CONCLUSIONS There is no significant increase in risks of patient as well as operating surgeon before the pandemic and during the pandemic when the elective operative procedure (arthroplasty) was allowed. Communication, precautions, and proper preoperative planning remain essential part of management at each step of treatment. By following above mentioned standard operative procedure (SOP) chances of getting infection of COVID-19 is negligible from operative work. KEYWORDS COVID 19, SARS-CoV-2, Arthroplasty, Orthopaedics

Acute Medicine and Pandemics: Getting It Right Next Time!

For those of you who are not aware of what GIRFT (Getting It Right First Time) is, let me start by saying it is a brilliant idea, genius perhaps. The vision of its founder, Professor Tim Briggs CBE, was to optimise orthopaedic care by using the most clinically and cost effective treatments, minimising waste, reducing variation and eliminating poor practice. Since 2014 in orthopaedics alone, operational and financial opportunities to save the NHS £696 million have been generated. Acute medicine, coupled with general medicine, has been part of the GIRFT programme since 2017. The mischievous reader might question the name, as clearly this is about getting things right at the second time of asking at the very earliest. Apart from that pedantic note, GIRFT is a force for good.

Can PROMIS measures be used to create subgroups for patients seeking orthopaedic care?

Aims Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care. Methods This was a cross-sectional study of patients from Duke University Department of Orthopaedic Surgery clinics (14 ambulatory and four hospital-based). There were two separate cohorts recruited by convenience sampling (i.e. patients were included in the analysis only if they completed PROMIS measures during a new patient visit). Cohort #1 (n = 12,141; December 2017 to December 2018,) included PROMIS short forms for eight domains (Physical Function, Pain Interference, Pain Intensity, Depression, Anxiety, Sleep Quality, Participation in Social Roles, and Fatigue) and Cohort #2 (n = 4,638; January 2019 to August 2019) included PROMIS Computer Adaptive Testing instruments for four domains (Physical Function, Pain Interference, Depression, and Sleep Quality). Cluster analysis (K-means method) empirically derived subgroups and subgroup differences in clinical and sociodemographic factors were identified with one-way analysis of variance. Results Cluster analysis yielded four subgroups with similar clinical characteristics in Cohort #1 and #2. The subgroups were: 1) Normal Function: within normal limits in Physical Function, Pain Interference, Depression, and Sleep Quality; 2) Mild Impairment: mild deficits in Physical Function, Pain Interference, and Sleep Quality but with Depression within normal limits; 3) Impaired Function, Not Distressed: moderate deficits in Physical Function and Pain Interference, but within normal limits for Depression and Sleep Quality; and 4) Impaired Function, Distressed: moderate (Physical Function, Pain Interference, and Sleep Quality) and mild (Depression) deficits. Conclusion These findings suggest orthopaedic patient subgroups differing in physical function, pain, and psychosocial distress can be created from as few as four different PROMIS measures. Longitudinal research is necessary to determine whether these subgroups have prognostic validity. Cite this article: Bone Jt Open 2021;2(7):493–502.

Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania

Background: Much of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health. Objectives: Our study investigates the role of bone setting in Tanzania through patient utilization and perspectives. Methods: We surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method. Results: Of all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-ad- ministered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67). Conclusion: Our study found lower bone setting utilization than expected considering the reliance of Tanzanians on tradi- tional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration. Keywords: Bone setting; traditional medicine; traditional practitioners; orthopaedics; trauma.