Surgical planning
There is surgical planning for
1) primary hip and knee joint replacements; and
2) revision joint replacements.
The primary arthroplasty meeting has been longstanding, the MDT service has been operational for approximately 3 years.
The primary arthroplasty academic surgical unit team interact with the junior fellows (for surgical planning and teaching) and each of the academic surgical unit consultants.
The revision MDT surgical planning team interacts with all surgeons who undertake revision hip and knee arthroplasty. This is because all cases must be discussed in the meeting prior to planned surgery.
The meeting is held on a weekly basis within the SWLEOC boardroom.
PACS data system is used for retrieving images (organised by admin staff prior to meeting if originating from another hospital).
For the revision MDT meeting, cases are identified prior to the meeting by a consultant who stores them in a virtual space for easy access on the morning of the meeting.
For the primary arthroplasty meeting, radiographs are downloaded (both, with and without pre-operative templating) before the meeting and put into a PowerPoint presentation. The medical history of the patient and relevant factors is also noted. Each case is discussed on an individual basis, and outcomes noted. The presentation is saved for future review if required.
For elective primary joint replacement, surgery is planned in the outpatient department using TraumaCad following a decision to book patients for surgery. Surgical planning is documented on the Bluespier computer-based patient management system. This database is reviewed by theatre staff during their planning of theatre lists. Staff can organise equipment and their company representatives based on the documented information for the planned procedure. The cases are reviewed in a weekly surgical planning and post-operative X-ray review meeting attended by senior arthroplasty surgeons.
For revision joint replacements, the patients are booked onto the revision MDT meeting for discussion every Wednesday. The clinician booking the patient writes a letter and presents their case to the MDT which can be attended face to face or remotely. The meeting is also attended by regional hospitals. There is a chairperson who runs the meeting. A plan is agreed on each case. If further imaging is requested if required, and the case is brought back. Post-operative images are reviewed the week after surgery in this meeting.
- IT infrastructure;
- internet failure hinders remote meetings;
- PACS failure makes accessing images difficult;
- access to information from other hospitals can be challenging.
The team overcame IT problems by using alternative computers, accessing the internet through mobile network, reschedule discussions, used images from other hospital systems
- Consider the capacity, capability and motivational factors;
- there needs to be enough resource / funding for equipment, room and staff time;
- staff need to be motivated to carry out their duties;
- it is important the environment is friendly, and all staff involved are respected.
- Weekly meetings, standard format engage with the team members;
- feedback and support to each participant as required;
- motivation of each team member;
- admin support – documenting cases discussed.