ON TRACKWITH ORTHOPAEDICS ISSUE #2

IN THIS ISSUE

- �SPORTSMED·SA hospital introduces overnight medical cover

- �SPORTSMED·SA orthopaedics opens in Victor Harbor

- Infection control in hospital

- Young hip pain by Dr Matthew Hutchinson

- Surgeon spotlight Dr Adrian Bauze

- Mystery patient initiative

SPORTSMED·SA�hospital�introduces�overnight�medical�coverIn a bid to continue providing the best possible orthopaedic care to our patients, SPORTSMED•SA has introduced an overnight medical cover team of four experienced doctors, to help monitor and treat our hospital patients overnight.

In addition to this onsite medical cover SPORTSMED•SA Hospital has also began a working partnership with another Adelaide private hospital who will offer intensive care support providing our nursing staff the opportunity to contact an Intensivist if required.

The new overnight medical cover initiative is a three-tier structure and approach to the management of a deteriorating patient. Our nursing staff are the first in line to address patient deterioration, followed by external intensive care specialists and the onsite medical officers.

To ensure the effectiveness of the enhanced patient management model additional initiatives have also recently been introduced. These include:

• Mandatory Advanced Life Support training for all Night Duty Registered Nurses and all members of the Hospital Coordinating team to ensure at least one ALS trained staff member is on every shift

• Mandatory training and updates to nursing practice related to detection, assessment and response to clinical deterioration

• Development of a nurse led Clinical Review Team which allows clear definition of clinician roles in the management of the deteriorating patient on every shift.

According to SPORTSMED•SA Hospital CEO Alan Morrison the new overnight medical cover initiative will provide patients with best possible care while admitted to SPORTSMED·SA Hospital.

“Our experienced nurses are the first line of response to a patient issue. They are highly trained and skilled in detection, assessment and care of the deteriorating patient and now can closely liaise with the onsite medical officers which will enhance our ability to make early interventions where required, “said Mr Morrison.

“The introduction of our overnight medical cover initiative will ensure that our patients are in the safest hands in case of an emergency.”

In the short term the medical officers will rotate and provide support to the overnight nursing staff on a part-time basis between the hours of 9.00pm to 7.00am on all operating days (Monday to Friday).

Although SPORTSMED•SA Hospital does not routinely operate on weekends, overnight medical cover may eventually extend to a seven-day service.

“There will still be some patients who will be deemed unsuitable for admission to SPORTSMED•SA due to requiring an intensive care unit as backup, however we have made arrangements so these patients can still be operated on by our surgeons within hospitals we have a relationship with that has such facilities.” Mr Morrison said.

“We have built relationships with other private Adelaide hospitals as it enables us to have greater control, follow up and continuity of care. This allows us to continue to collect the data from clinical processes, standards and peer reviews, ensuring that clinical audits are still being collected and captured and performed.”

Together with our overnight medical cover enterprise this improved model is a positive initiative to provide a safer environment for the patients admitted to SPORTSMED•SA Hospital.

SPORTSMED·SA�orthopaedics�opens�in�Victor�HarborThe Fleurieu Peninsula will get new and expert orthopaedic consultation services starting next month when SPORTSMED•SA – one of South Australia’s leading orthopaedic and sport medicine specialist groups – opens a consultation branch in Victor Harbor.

Orthopaedic surgeons with specialities in upper and lower limbs, including joint replacement, will begin consulting in late April.

CEO of SPORTSMED•SA Hospital and Orthopaedics, Alan Morrison said the new services in Victor Harbor sees SPORTSMED•SA continue its commitment to give all South Australians access to quality and innovative orthopaedic and sport medicine care regardless of where they live.

“We know that when an injury or ailment occurs you put your life on hold and stop doing the things you love – whether that’s work, sport, travel or spending quality time with your family,” Mr Morrison said.

“Three of our specialist upper and lower limb surgeons will be heading to Victor Harbor on a rotational basis with consultations available weekly.

“By expanding SPORTSMED•SA services to Victor Harbor, we know we can offer patients access to well-respected orthopaedic surgeons that can help find them a solution and help get them back on track, and back doing the things they love.

“This expansion of SPORTSMED•SA services is excellent news for residents in the Fleurieu Peninsula as it provides local and easy access to specialist services. We want to make it easier for our local patients to get back on track and back to health.”

Specialising in the treatment and recovery of orthopaedic, sporting, musculoskeletal and arthritis conditions, SPORTSMED•SA Orthopaedics is committed to providing excellence in patient care and all patients that require any surgical treatment will have access to a modern, specialist private hospital based in Stepney.

Immediate�appointments�are�now�available.��Consultations�begin�27th�April�2015.

To�make�an�appointment�call�08�8362�7788.

Infection�control�in�hospitalSPORTSMED•SA Hospital is pleased to advise that our infection rate data is available on our website. The data is updated annually and provides GPs and patients the information they may need to make an informed choice about hospital selection.

We are proud to have an outstandingly low post-operative infection rate and we work consistently towards finding more ways to prevent infections for our patients.

The hospital has a number of practices in place to minimise infections for patients identified as higher risk, including a dedicated Infection Control Coordinator and Pre-Admission Coordinator.

Unlike many other hospitals, our surgeons are able to communicate any infection outcomes following discharge from the hospitals at post-discharge appointments. This allows us to track infection rates for longer than many other facilities.

While we recognise there is a risk of post infection after a surgical procedure which we monitor, we also treat past patients for “late onset” infections.

Such infections occur well past the surgery episode and are due to many other mitigating circumstances such as co-morbidities or secondary infections that occur long after the patient’s surgical experience.

SPORTSMED•SA takes infection prevention extremely seriously and have practice aimed at pre-operative screening for MRSA & VRE (MROs). As a consequence of this initiative our hospital has never had an “in hospital” or healthcare acquired MRO infection, and has processes to manage those patients who do present pre-operatively with MROs to prevent the risk of cross infection.

We actively participate in National Hand Hygiene auditing and reporting, and can proudly boast that we are consistently meeting on average 85% compliance when compared to the industry average of 75%.

Our newest campaign “it’s timely and rightly for 90” is to encourage hand hygiene compliance to be maintained at 90%. Hand hygiene compliance is a known preventative measure to healthcare acquired infections.

To�view�our�latest�infection�rate�data�or�any��of�our�other�quality�initiatives,�visit�our�website��www.sportsmed.com.au

DR. TONY SPRIGGINSORTHOPAEDIC SURGEONKnee and Hip Specialist

DR. MATTHEW HUTCHINSONORTHOPAEDIC SURGEONHip and Knee Specialist

DR. DOMENIC LEONELLOORTHOPAEDIC SURGEONUpper Limb Specialist

Young�Hip�Pain�by Dr Matthew Hutchinson�

Our understanding of hip pain in younger patients (from adolescence through to adulthood) has improved dramatically in recent years. So too has the quality and availability of MRI and other imaging modalities to more accurately diagnose its many causes.

Orthopaedic surgeons today also have a far greater range of treatment options for patients of all ages that experience hip pain. Much of this is due to the technological advancements of hip arthroscopy and improved bearing surfaces for total hip replacements.

Younger patients can experience hip pain for many reasons. The list of potential causes and treatments may include:

Femoro-acetabular-impingement�(FAI)FAI is a complex cause of hip pain where the ball and socket of the hip joint bump into each other during movement. This causes scuffing and tearing of the labrum (a cartilage ring around the hip socket) and may lead to early arthritis.

Pain is typically felt in the groin, but can be referred laterally or posteriorly. Plan radiographs may help with the diagnosis, but an MRI is the gold standard.

Surgical treatment includes hip arthroscopy to shave away excess bone that is the underlying cause of the damage and to repair the torn labrum.

Labral�tearsAlthough commonly seen in association with FAI, labral tears can also occur by themselves. Pain is often felt in the groin with hip flexion and internal rotation. Hip arthroscopy can also be an option to repair the labral tear.

Early�onset�arthritisYounger patients may develop arthritis earlier than we would typically expect. This may be due to a genetic predisposition, the outcome of FAI, or residual pathology from paediatric conditions such as developmental dysplasia of the hip (DDH), SCFE and Perthes’ disease.

Arthritic hips tend to respond poorly to hip arthroscopy, hence why early hip replacement may be the only surgical treatment for these patients. Advances in the bearing surfaces of modern hip replacements mean that younger, more active patients can benefit from hip replacement with an improved prognosis in terms of the lifespan of the hip replacement. Regardless, a hip replacement for a younger patient is still an important decision and one that should only be made when all other non-operative measures have been exhausted.

Trochanteric�bursitisPain is most often felt laterally over the greater trochanter and is commonly tender to palpation. It can often respond well to stretching and/or steroid injection. Sometimes surgical excision of the bursa is required.

Referred�pain�from�the�backA very common cause of hip pain that is important to exclude. Symptoms can include pain that is ‘burning’, ‘electric’, or ’shooting’

and can be associated with a reasonably normal range of hip motion. An MRI of the lumbar spine can assist with the diagnosis.

Snapping�HipClicking, catching and popping around the hip joint associated with movement are the common causes. This may be caused by a tight illio-tibial band snapping over the greater trochanter from an inflamed psoas tendon catching over the front of the hip joint or from intra-articular pathology within the hip joint itself. Physiotherapy and a targeted steroid injection are often enough to solve the problem. An MRI and orthopaedic assessment can assist with the diagnosis while surgical treatment options are available if non-operative measures fail.

Femoral�neck�stress�fractureMore common in thin, fit, highly active female runners and gymnasts, this is a reasonably rare cause of hip pain. Plain x-rays and/or CT/MRI can confirm the diagnosis. Management may include crutches and activity modification to allow the fracture to heal or surgical stabilisation of the fracture.

Slipped�capital�femoral�epiphysis�(SCFE)This occurs only in children/adolescents that are still growing and usually in their early to mid-teens. A SCFE is a fracture through the growth plate of the proximal femur. A plain radiograph of the pelvis is sufficient to diagnose this condition. It requires urgent orthopaedic referral for surgical stabilization of the fracture.

The above list is not exhaustive, but should serve as a useful guide for diagnosing the bulk of hip pain causes in younger patients. If you have questions about any of your patients, please do not hesitate to contact one of our hip surgeons or refer for an opinion.

www.sportsmed.com.au

Our mailing address is:

SPORTSMED•SA32 Payneham RoadStepney, SA 5069Australia

Mystery�Patient�Initiative�At SPORTSMED·SA we are always trying to find ways to further improve on our services. In early 2015 we will be introducing a mystery patient initiative in a bid to further improve patient interaction and satisfaction.

Similar to the ‘mystery shopper’ concept utilised in the retail industry, a SPORTSMED·SA patient will detail their experience with us from start to finish.

We will approach a patient who consults with one of our orthopaedic surgeons and requires surgery, and explain the program.

If the patient is willing to participate they will be instructed to critique and provide feedback on all aspects of the hospital and orthopaedic clinic including surgeon interaction, patient care, cleanliness etc.

We will then engage with the patient at the conclusion of their time with us to collect and examine the feedback.

SPORTSMED·SA CEO Alan Morrison said the patient will not be told what to focus on when critiquing, but rather given free reign to evaluate the organisation as a whole.

“We want the patient to go into the process with their eyes open - not leading them and saying ‘look at this and look at that’,” he said.

“We might ask them a couple of specific things, but it’s more in general that we ask them to be really critical and prepared to come and see us again at the end of the journey to explain what they felt was good and bad, and what suggestions they may have to help us improve.”

Mr Morrison also highlighted the importance of adding a personal touch to the whole process for the participating patient.

“After reviewing the patient’s feedback we would then actually go back to them again further down the track by having myself or the Director of Nursing and Clinical Services directly call to say thank you their participation,” he said.

“We would also inform them that we have taken their feedback onboard and discuss some of the changes or improvements we may have already made.

Surgeon�Spotlight�Dr�Adrian�Bauze

Dr Adrian Bauze is an Orthopaedic surgeon who specialises in hip and knee surgeries.

Consulting from our Stepney, Kurralta Park and Victor Harbor branches, as well as at St Agnes Specialist Centre Dr Bauze specialises in arthroscopy of the hip and knee, anterior cruciate ligament reconstruction, hip and knee replacements and computer assisted surgery of people of all ages.

Qualifications�and�experience› Bachelor of Medicine and Bachelor of

Surgery, University of Adelaide› Fellowship of the Australian Orthopaedic

Association › Fellowship of the Royal Australasian College

of Surgeons› Additional training in joint replacements and

sport injuries of the hip and knee in Exeter, UK and at SPORTSMED·SA

› Former Club Doctor, Norwood Football Club› Former Head of Orthopaedic Surgery,

Lyell McEwin Hospital› Advanced Diploma of Management,

University of New England› Graduate, Australian Institute of

Company Directors› Specialist hip and knee surgeon since 2004

Awards�and�achievements› Member, Board of Directors, SPORTSMED·SA

Hospital and Orthopaedics› Past President, Australian Orthopaedic

Registrars Association› Author of numerous scientific articles on

innovative techniques in hip and knee surgery

Consultations�available�at› SPORTSMED·SA Stepney› SPORTSMED·SA Kurralta Park› SPORTSMED·SA Victor Harbor› SPORTSMED·SA Darwin› St Agnes Specialist Centre

Personal�interestsFamily, skiing, playing tennis, football, cricket, soccer

Dr�Bauze�has�immediate�appointments�available�now�for�your�patients.�To�make�an�appointment�at�one�of�his�consulting�locations�please�contact�(08)�8362�7788.

“It just closes that loop of the patient’s journey and provides a professional start to end.”

At this stage two patients are participating per a month with a total of 24 evaluating their experience annually.

SPORTSMED·SA staff will be informed of the program, but will not be told of a date or time for mystery patient appearances.

By introducing the initiative we hope to achieve outcomes in, raising organisational standards and community engagement.

The program will give staff, particularly those in administration, an appreciation, understanding and perspective on what it would be like as a patient at SPORTSMED·SA Hospital and Orthopaedics.

Standards within the organisation are also expected to increase just by the virtue of having a mystery patient on site.

Engaging and sending out positive messages to the community can also be achieved.

“Taking on mystery patients sends a good message out to the community that we are serious about what we’re doing,” Mr Morrison explained.

“It shows we’re open and seeking feedback, and we will respond accordingly.

“In particular having very senior people call, follow up and close out the process, hopefully encourages those people to go back out and become advocates in the community for us.”

Under new national standards to partner with consumers, the mystery patient proposal will also contribute towards meeting our obligations as a hospital to engage with patients to deliver better quality care outcomes.

“The mystery patient initiative is another really positive project for SPORTSMED·SA - It’s something different that sets us apart,” Mr Morrison said.

“We serve our patients well and get good feedback, but we can always get better.”