Musculoskeletal (MSk) Audit

The Musculoskeletal (MSk) Audit

The Musculoskeletal (MSk) Audit began in April 2009 and will provide data to complement the work of various hospital time-to-treatment teams by identifying rate-limiting steps for orthopaedic treatment. This will help orthopaedic departments meet their December 2011 Referral to Treatment target of patients waiting no longer than 18 weeks from receipt of a referral (e.g. from a GP) until starting treatment.

Funding for the audit has come from the Scottish Government’s Health Delivery Directorate. The audit resources have been transferred from the previous successful Scottish Hip Fracture Audit (SHFA) which completed data collection at the end of 2008, providing us with experienced Local Audit Co-ordinators throughout Scotland. The MSk Audit will now work closely with the orthopaedic Task and Finish Group auditing access to musculoskeletal services.

The MSk Audit will complement, not duplicate, the work of the 18-week Referral to Treatment teams already established in each hospital by identifying rate limiting steps in the orthopaedic patient’s journey at both a local and national level.

So far we have…

Completed a large scoping exercise in April 2009 looking at the referral to diagnostic stage of the patient’s journey. This provided the Task and Finish group with a national picture of then current practice.
Produced monthly datasets detailing orthopaedic activity and demand for orthopaedic services, and additional activity undertaken at each site/board.
Reported to hospitals on care pathways for patients undergoing knee arthroscopies from September to December 2009 (1380 patients from 16 units). This was the first of a series of condition- or time-specific audits of targeted groups of patients, intended to identify and highlight particular obstructions in specific and general care pathways.
Reported to hospitals on care pathways for carpal tunnel surgery patients undergoing operations from January to April 2010 (1218 patients from 16 units).
Advised hospitals on their use of Enhanced Recovery After Surgery (ERAS) principals for hip and knee arthroplasty patients undergoing operations from May to August 2010 (1345 patients from all 22 mainland operating units).
We have also provided the Scottish Government with further ad hoc analysis of the above data, and helped facilitate and inform clinical and other pathway meetings.

What’s next?

Data collection for patients attending hospitals for outpatient appointments for back/spinal conditions (September to December 2010)
Data collection for care pathways of carpal tunnel syndrome patients referred to hospitals between January and April 2010, including those treated conservatively. As diagnostics and final treatment of these patients can occur over a long period, we are interested in describing the progress of these patients at 12 months post-referral.
Repeat audit of Enhanced Recovery After Surgery (ERAS) principals for hip and knee arthroplasty patients (spring/summer 2011), reporting the extent to which ERAS principals have continued to be introduced across Scotland
Future audit subjects will be determined by requests from clinicians and health professionals, 18-week Referral to Treatment teams and members of the Access Support Team, Health Delivery Directorate, Scottish Government.