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
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-Re...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e058316.full |
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| author | Stephen Morris James Mason Rosalind Raine Peter Martin Naomi J Fulop Elena Pizzo Andrew Hutchings Helen Barratt Jean Ledger Raj Mehta Sarah Jasim Fiona Aspinal Rafael Gafoor |
| author_facet | Stephen Morris James Mason Rosalind Raine Peter Martin Naomi J Fulop Elena Pizzo Andrew Hutchings Helen Barratt Jean Ledger Raj Mehta Sarah Jasim Fiona Aspinal Rafael Gafoor |
| author_sort | Stephen Morris |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-c6da65df5cdb45e58463b066499d32b9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
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| series | BMJ Open |
| spelling | doaj-art-c6da65df5cdb45e58463b066499d32b92025-01-24T02:30:09ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-058316Mixed 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 StatisticsStephen Morris0James Mason1Rosalind Raine2Peter Martin3Naomi J Fulop4Elena Pizzo5Andrew Hutchings6Helen Barratt7Jean Ledger8Raj Mehta9Sarah Jasim10Fiona Aspinal11Rafael Gafoor12Department of Public Health and Primary Care, University of Cambridge, Cambridge, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKDepartment of Applied Health Research, University College London, London, UKGastroenterology, Barts and The London NHS Trust, London, UKDepartment of Applied Health Research, University College London, London, UKDepartment of Applied Health Research, University College London, London, UK7London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, United KingdomDepartment of Applied Health Research, University College London, London, UKDepartment of Applied Health Research, University College London, London, UKfamily medicine physicianCare Policy and Evaluation Centre, The London School of Economics and Political Science, London, UKDepartment of Applied Health Research, University College London, London, UKDepartment of Applied Health Research, University College London, London, UKObjective 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.https://bmjopen.bmj.com/content/12/6/e058316.full |
| spellingShingle | Stephen Morris James Mason Rosalind Raine Peter Martin Naomi J Fulop Elena Pizzo Andrew Hutchings Helen Barratt Jean Ledger Raj Mehta Sarah Jasim Fiona Aspinal Rafael Gafoor 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 BMJ Open |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://bmjopen.bmj.com/content/12/6/e058316.full |
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