Quality and Patient Safety report 2023
Summary
For Ledplastikcentrum, the year 2023 has brought development and changes in several areas of the operation. The patient safety work has focused on systematic improvement efforts, staff development, and enhanced quality control. The analysis of the outcomes from 2022 showed positive results in nearly all areas; however, deep infections occurred with a slightly higher frequency than expected. Therefore, significant emphasis has been placed on infection prevention throughout the year. Data collection, analysis, actions, and evaluation have been conducted in parallel sequences, leading to the implementation of four action packages over time. This has had a significant positive impact on the outcomes for 2023:
1,722 out of 1,763 patients, or 98%, underwent surgery without complications.
Only 16 patients out of 1,763 developed a deep infection, corresponding to 0.9%.
These figures are based on self-reporting up to February 28, 2024. Some instances of underreporting cannot be ruled out.
Regarding the patient safety culture in the workplace, the management team has aimed to create an environment where immediate feedback and suggestions for improvement are encouraged. All colleagues have been trained in the incident reporting system to support the management of unwanted healthcare events.
In 2024, the clinic will continue its various improvement efforts. Reducing the number of medication errors and preventing postoperative complications in various areas remain priorities. The work on infection prevention will continue.
Employees are encouraged to pursue professional development, and opportunities are created through internal training for further development within their specific professions.
Overall Goals and Strategies
Ledplastikcentrum has a goal and action plan that is updated annually, with a significant focus on patient safety factors. The overall goals concerning patient safety for 2024 are to reduce the number of:
Deep infections
Perioperative fractures
Hip dislocations
Medication errors
LÖF cases (Swedish patient insurance)
Incidents leading to patient harm
Falls and fainting in the department
Samverkan för att förebygga vårdskador
Collaboration occurs across a range of our processes. Thanks to the clinic having its own outpatient clinic, inpatient department, operating department, sterile supply unit, and postoperative unit within the same organization, the risk of misunderstandings between different units is minimized. All units are located on the same floor, and staff members interact across all departments. To reduce risks during the surgical process, we utilize the WHO checklist during reporting and when transferring the patient from the operating department to the postoperative unit, and subsequently to the inpatient department.
Internal collaboration takes place in regular meetings. On Wednesdays, recurring surgical planning meetings are held to ensure that all patients scheduled for the following week have been assessed for risk by the anesthesiologist, and that all necessary examinations have been completed with approved results for surgery. We verify that X-ray images are available, that all necessary equipment is in place, and that implants are stocked in the clinic.
Once a month, we hold a meeting with anesthesia and surgical staff to continually improve collaboration and processes. Suggestions from employees are discussed through a shared improvement board and are raised in the group. This process develops the clinic’s working methods and responsiveness to staff experiences and ideas. The inpatient department holds similar meetings with the responsible manager.
APT (Staff Development Meetings) occurs every six weeks, where the entire staff is invited. Current events, incidents, and improvement efforts are addressed, and staff members are updated on the management team’s work.
Annually, we hold a conference to enhance competence and develop collaboration among employees.
The main areas for external collaboration include:
Referrals from primary care and re-referrals: We receive electronic referrals from all healthcare providers in the region using the Take Care system, which includes the majority. This reduces the risk of referrals being misplaced or lost. Referrals are reviewed daily on weekdays. When patients are discharged from the Joint Replacement Center or require investigation of other conditions, a referral is sent to the relevant institution.
Referrals for laboratory testing and EKG: Non-urgent lab samples are handled by Unilabs, located in the same building, using electronic referrals in Take Care. EKGs are performed at the outpatient clinic during the visit.
Referrals for imaging: All patients from Stockholm are referred electronically. To facilitate referrals, templates for postoperative and preoperative images have been created. Out-of-region patients are referred for imaging in their home region using printed paper referrals. All patients are reminded via appointment notifications to undergo imaging studies, and if this does not occur, it is addressed during follow-up with the surgeon.
Referrals from other orthopedic clinics: We regularly receive referrals from other orthopedic clinics in Stockholm as well as from regional orthopedic clinics. We maintain contact with referring orthopedic surgeons when there are uncertainties and have good communication with ordering hospitals in several regions. Travel to and from our unit is coordinated with the respective region's travel unit.
Referrals to other healthcare units, both urgent and elective: In cases of emergencies, we contact hospitals in the Stockholm region, where we both call the receiving specialist and send a referral. We encourage regular contact with us and strive to be accessible to hospitals, for example, by providing direct phone numbers. When a patient is deemed to require the resources of an emergency hospital, a referral is sent based on the patient’s preferences.
Collaboration with partners: This includes our current collaboration with the physiotherapists at Stockholm Sjukhem. We work together with Stockholm Sjukhem, which staffs our unit with physiotherapists. We hold regular check-ins, share experiences, and design working methods that assist patients both during and after their stay at the Joint Replacement Center.
Paper referrals to district nurses: For wound checks and potential suture removal at an external provider in the home region for out-of-area patients, the patient is given a paper referral to the district nurse. The referral includes a request for feedback after the wound check to be informed about any complications regarding wound healing.
Information Security
Information security at the system level is based on the guidelines for information security established by Region Stockholm. A detailed description is documented in the clinic's management system. In summary, only secure and proven systems are used, primarily provided by Region Stockholm, including networks and servers where personal data is processed. Two systems are external:
IDS7 by Sectra, delivered by Unilabs. The data is stored on Unilabs' servers, with access for us via VPN.
WX3 for patient communication via phone, web, and mobile applications.
For paper records, locked filing cabinets are used, and anything that is digitized or does not need to be archived is destroyed using designated confidentiality containers.
Ongoing Work:
Clinic staff undergo basic training (DISA) upon employment.
Log monitoring of medical record access in TakeCare is conducted monthly with the help of SALA.
System updates
Incident reporting
Compliance follow-up
Adequate Knowledge and Competence
All staff members possess adequate education and extensive experience in their roles. Staffing and scheduling are managed within each profession, ensuring that competency levels are always more than sufficient. In 2023, the organization increased its night staff from two to three employees to enhance patient safety through increased availability.
To improve redundancy and reduce the need for temporary staff, personnel from the department work in the postoperative unit when needed.
Specialized staff from the inpatient, sterile, surgical, and anesthesia departments have undergone various forms of training to develop and promote the different areas of the organization.
An example of this is a cross-professional group from the organization that conducted an infection prevention training course offered by the National Association for Surgical Care in the fall. This course has generated improvement efforts through Care Bundles, which the clinic is actively implementing.
Improvement initiatives at the clinic are carried out in collaboration with employees, providing the best possible conditions for engagement and knowledge regarding improvements and their implementation.
The Patient as a Co-Creator
At Ledplastikcentrum, patient participation in care is essential for achieving positive outcomes. This involvement begins as early as the appointment scheduling, where patient feedback and preferences have led to various solutions for the initial contact with the Joint Replacement Center. Open discussions about treatment options and significant patient influence are natural components of elective care and are fundamental at the clinic.
In addition to our advisory services available during weekdays, the Joint Replacement Center has developed an app in 2023, accessible with Bank ID through the clinic's website. This provides patients with an additional channel to facilitate contact with the clinic.
During the fall, the Joint Replacement Center also engaged a PR agency to enhance the clinic's presence on social media. This initiative has generated additional channels for both current and prospective patients to access information and obtain contact details for the clinic. The social media team aims to respond to inquiries on our channels within 48 hours.
To promote and optimize the clinic's pain management during the care process, a survey study has been conducted in which patients evaluated their pain during various stages of treatment. This feedback is then reviewed by the responsible anesthesiologist.
Acting for Safe Care
Self-monitoring is a significant component of the Joint Replacement Center's patient safety efforts. 2022 marked the first clinically operational year for the organization. A variety of processes and metrics were tracked concurrently, most of which performed well. However, it gradually became evident that there was a slightly higher frequency of wound and infection issues than expected. This delay in data is typical, as it often takes 3–4 weeks for an infection to present itself. Moreover, it is challenging to draw conclusions from occurrences that happen infrequently and seem random. By the end of 2022, it was clear that the incidence of reoperation due to infection was above what was anticipated, particularly regarding hip replacements, but it was also noted for knee replacements.
As a result, the focus in 2023 has been on infection prevention, approached from four angles:
Analysis of Occurred Cases: Investigating the presence of risk factors and any common factors among cases.
Measurement of Compliance: Assessing adherence to established infection prevention protocols.
Assessment of Known Risk Factors: Evaluating recognized risk factors for infection.
Literature Review: Exploring additional possible interventions through literature studies.
From the outset, the clinic’s procedures have followed PRISS recommendations. Checks have been conducted to verify the clinic's compliance with guidelines, without revealing any systematic deviations. In addition, known risk factors such as hypothermia, time to a dry dressing, and the number of dressing changes have been monitored. Moreover, four intervention packages have been implemented throughout the year, along with associated measurement parameters according to the Care Bundle principle. These interventions are based on research in infection prevention, where the evidence does not reach a sufficient level for the measures to be recommended in consensus documents or general guidelines. Nevertheless, these measures have shown a small to moderate effect on infection risk or risk-associated parameters. One example is iodine-prepared incision film, which is not generally recommended but has demonstrated a reduced risk of superficial infection in other types of surgery, such as thoracic surgery.
Below are examples of self-monitoring and actions taken throughout the year.
Antibiotic Timing
Antibiotic Timing in Relation to PRISS Recommendations
According to the PRISS guidelines, the initiation of antibiotic infusion should commence 30–45 minutes preoperatively. This recommendation is based on studies indicating the lowest occurrence of deep infections when antibiotic infusion is completed 0–60 minutes prior to the surgical incision.
2023 Data Collection on Antibiotic Timing
In 2023, data were collected regarding antibiotic timing during 292 surgical procedures at Ledplastikcentrum. The findings are as follows:
Adherence to Guidelines: 73% of the antibiotic administrations occurred within the recommended 30–45 minute window before surgery. This indicates a high level of compliance with PRISS recommendations among the surgical team.
Box Plot Analysis: The box plot analysis illustrates a small spread in the timing of antibiotic administration, predominantly skewed towards the earlier timeframes. This suggests a consistent practice among the team.
Timing Exceeding 45 Minutes: In cases where the antibiotic administration exceeded 45 minutes, it was noted that an additional dose of antibiotics was given to maintain adequate prophylactic levels. This practice aligns with the need to ensure effective serum levels during surgery.
Clinical Relevance of Timing: Based on the previously mentioned study, administering antibiotics earlier than 30 minutes before the incision is likely to have minimal clinical relevance. Therefore, while operators could technically wait until the 30-minute mark, this must be weighed against the potential disadvantages of extended anesthesia for the patient.
Action Plan for Improvement
To enhance adherence to the PRISS recommendations while prioritizing patient safety, the following measures will be implemented:
Education and Training: An ongoing educational initiative will be established for the anesthetic team to emphasize the importance of timely antibiotic administration, particularly focusing on aiming for the 30-minute preoperative mark.
Protocols for Administration: Clear protocols will be reinforced, encouraging anesthesiologists to initiate antibiotic infusion slightly earlier in order to consistently meet the recommended timeframe.
Monitoring Compliance: Regular audits of antibiotic timing practices will continue to ensure compliance with the updated protocols and identify areas for further improvement.
Patient Safety Considerations: Discussions regarding the balance between optimal antibiotic timing and the implications of prolonged anesthesia will be included in team briefings and decision-making processes.
By implementing these strategies, the Joint Replacement Center aims to improve the timing of antibiotic administration, thereby further reducing the risk of deep infections and enhancing patient outcomes.
Body temperature
In the same cohort as the antibiotic timing, temperature measurements were also conducted. The background is that when body temperature drops below 36 degrees Celsius, the risk of postoperative infection increases, likely due to impaired immune function.
The diagram shows body temperature measured at the time of anesthesia induction on the left and at the time of awakening on the right. It can be noted that patients are adequately warm during induction, but on average, their temperature drops by 0.3 degrees Celsius during surgery. As a result, approximately half of the patients fall below 36 degrees Celsius. Measures that have been implemented include raising the temperature in the operating room, using warmed irrigation fluids, and applying warming blankets preoperatively. Follow-up measurements will be conducted in the spring of 2024.
Need for Dressing Changes During Hospitalization
Postoperative dressing changes indicate a surgical wound that is not fully sealed, sometimes accompanied by increased bleeding. Studies have shown an increased risk of infection for each day a wound is exudative.
The diagram illustrates the percentage of patients requiring dressing changes during their hospitalization. Measurements have been conducted as point prevalences over two-week periods in the spring and fall. The proportion of patients needing dressing changes is somewhat high. However, the trend is decreasing, and efforts to reduce the need for dressing changes continue. The methods employed include changing suture materials, standardizing suture techniques, and altering the type of dressings used. Additionally, the prescription of cyklokapron has been adjusted, which may have had a positive effect. Planned measures include further developing techniques for wound closure, such as using tissue adhesive.
To enhance understanding of wound-related issues, statistics on dressing changes between discharge and suture removal are now being collected. This work is still in the data collection phase.
Wound Film
Ioban wound film is now used for all surgeries. The scientific support for its efficacy in reducing wound infections during various types of surgery is considered to be neutral to clearly positive.
Glove Changes
Harmonization in the form of mandatory glove changes during the handling of implants is verified with a control question at checkout. This is unlikely to have a significant impact on perioperative contamination, and there are no apparent negative factors, apart from a limited environmental and economic impact.
CFU Measurement
CFU stands for colony-forming unit and is a method used to indirectly measure air cleanliness. Five growth plates are exposed in the operating environment during an ongoing surgery, and subsequently, the number of bacterial colonies that grow is counted. The guideline for joint prosthesis surgery is a value of less than 5 CFU. The measurements indicated that Ledplastikcentrum's operating rooms have a value of 0.2 CFU. No actions are planned.
Outpatient Clinic
A need was identified during the year for easy access to medical assessments and CRP testing at the outpatient clinic. The response to this need was to allocate a specific time each day for doctors on duty at the clinic to address urgent inquiries, as well as to procure a machine for local CRP analysis.
In the preoperative assessment, alcohol consumption has been included to identify patients with risky drinking behaviors, thereby increasing awareness of the associated risk of complications. The testing method has been changed from blood glucose to HbA1c to facilitate the diagnosis of glucose intolerance and to evaluate control in diabetic patients.
Ward
The routine for the management of patients with diabetes mellitus has been revised to a simpler and clearer format. The ward nurses have been trained on the importance of meticulous blood glucose monitoring in the postoperative phase and during the first night after surgery.
The anticoagulant regimen has been adjusted to reduce postoperative bleeding without an increased incidence of thrombosis.
Outcomes 2023 Compared to the Swedish Hip Arthroplasty Register
In 2023, a gradual improvement in infection rates was observed as the intervention packages were implemented. The final results are based on self-assessments up until February 28, 2024, and are considered to encompass virtually all deep infections. Other complications may involve a degree of underreporting.
The list below shows the number of reoperations due to verified infections and other causes.
The incidence over the year demonstrates a favorable decreasing trend, suggesting that the interventions have had an effect. However, the time frame is too short to statistically exclude the impact of chance.
Hip Arthroplasties
Infection: 1.3% (1.2%)
Dislocation: 0.1% (0.3%)
Fracture: 0.4% (0.2%)
Total Knee Arthroplasties
Infection: 0.4% (0.8%)
Other causes: 0.5% (1.1%)
The figures for the Ledplastikcentrum are shown in black, with the national average for 2019-2022 in purple parentheses.
Increasing Knowledge of Occurred Adverse Events
Increasing Knowledge of Occurred Adverse Events
Through the identification, investigation, and measurement of injuries and adverse events, knowledge increases regarding what patients experience when the outcomes of care do not meet expectations. Understanding the underlying causes and consequences for patients provides a basis for designing interventions and prioritizing efforts.
Events that have caused or risked causing adverse events are followed up depending on the nature of the incident. In a surgical environment, there is always a risk of adverse events resulting from treatment complications. If these are of an expected nature and scope, they are followed up and evaluated by the involved staff immediately after the incident. An example is syncope during early postoperative mobilization. This is a common complication after anesthesia and falls within what can be expected after a prosthesis operation.
Adverse events are reported in the incident reporting system and are then investigated by the nearest supervisor, sometimes in conjunction with the clinic's quality controls, before being forwarded to the management group.
In 2023, the clinic's quality controls, along with the medically responsible physician, conducted a root cause analysis following an incident that led to an external report to the Health and Social Care Inspectorate (IVO). The analysis concluded that the unit did not cause direct harm but identified risk areas that the clinic has since utilized in its improvement efforts. Below are described these risk areas along with other risks highlighted by the clinic's incident reports.
Prioritized Risk Areas:
Postoperative Renal Failure: The goal is for the primary risk assessment to be conducted by the operator based on age, medical history, and creatinine/estimated GFR. A renewed risk assessment is performed by the anesthesiologist. Given the standardized medication protocols, the ward nurses also check renal values against age and prescribed doses of NSAIDs before administration to avoid incorrect dosing.
Postoperative Wound Infection: Risk assessment by the operator based on PRISS guidelines. Patient optimization preoperatively. Control of the surgical environment and antibiotic prophylaxis. Ongoing evaluation of wound closure techniques. Minimization of the need for dressing changes.
Minor Wound Issues: To prevent and mitigate wound healing complications, statistics have been collected to evaluate if there is a correlation between patients who experience complications. Changes in suture selection have been made, and a CRP machine has been procured to better assess the wound.
Postoperative Falls and Syncope: The majority of incident reports consist of falls with or without preceding syncope. Risk assessments are conducted by nursing staff during each initial mobilization to determine if the patient is stable enough to mobilize independently without supervision. This is then documented in the clinic's medical record system, Take Care.
Medication Errors: Ledplastikcentrum operates based on a standardized care pathway to strive for equitable care. This includes the use of predefined templates for medication prescriptions. The risk associated with this is that each patient's prescriptions may not be individually tailored, leading to inappropriate medication orders. To mitigate this, the templates have been updated to require mandatory considerations. Additionally, ward nurses are encouraged to provide feedback on incorrectly prescribed medication lists to the responsible operator, and an incident report should be filed.
Reliable and Secure Systems and Processes
The operations of Ledplastikcentrum are limited to elective hip and knee arthroplasty. This makes it well-suited for standardized processes with few external disturbances. Deviations in the procedures are also easier to identify. Templates and checklists provide valuable support, while any aspects that require individual customization fall outside these and are addressed on a case-by-case basis. Employees’ adherence to the processes is continuously evaluated, as is the compliance of the processes with what is considered best current practice.
Throughout the year, several routines have been evaluated and updated, including those mentioned above, such as antibiotic prophylaxis, hypothermia prevention, and diabetes management.
New procedures have been introduced to harmonize the implementation of more commonly performed actions. Examples of this include wound dressing, management of urinary retention, and thromboprophylaxis.
Basic hygiene routines have been measured through self-reporting.
Monitoring of perioperative moments, such as antibiotic timing, glove changes during implantation, and body temperature, has verified compliance with the routines.
Safe Care Here and Now
Ledplastikcentrum, like all healthcare organizations, faces the risk of disruptions to various necessary functions. In the event of a more serious disruption that threatens the quality of care, there is always the option to cancel or postpone scheduled surgeries, although this is undesirable from both the patient's and the organization's perspective. Therefore, these functions are planned with a reasonable level of redundancy, as outlined below.
Staffing – Certain overcapacity, established contacts with staffing agencies, and part-time employees.
Supplies – Alternative replacement systems for prosthetics, maintaining an inventory of consumables and medications.
Patient Beds – In 2023, additional patient beds have been completed in the department. Moreover, there is a possibility of overflow in the post-operative department and collaboration with Stockholm Sjukhem.
IT – The medical record system, X-ray images/BFT, and internet connectivity are provided via the fixed SLL network. In the event of issues with the local infrastructure, selected staff members have access to a SAM account for connectivity via mobile networks and VPN.
Risk Management
Healthcare providers must continuously assess whether there is a risk that events could occur, potentially leading to deficiencies in the quality of services. For each such event, the provider should estimate the likelihood of the event occurring and assess the negative consequences that could follow.
Risk analyses in various areas are documented in the organization's management system. Examples of risk analyses include information security, disruptions in IT and medical record systems, and radiation safety.
The different departments within the organization continuously work on risk assessments as part of their daily operations. Examples of this are outlined below:
Ongoing risk assessments are conducted each morning at a startup meeting where staff gather to review the day's planned surgeries, any deviations regarding patients, the operation of surgical rooms, the sterilization department, supplies, and staffing.
Prior to each post-operative mobilization, the staff work in teams of two to minimize the risk of falls. The responsible nurse then assesses how the patient can be mobilized safely. This is documented in the patient's care status and is continuously evaluated throughout the hospitalization period.
Assessments regarding the patient's ability to benefit from rehabilitation and manage independently at home postoperatively are conducted during the outpatient visit before surgery. The patient is evaluated based on their circumstances and functional level.
When staff members document an incident, it is mandatory in the documentation to assess whether the event was a risk or of another nature.
Strengthening Analysis, Learning, and Development
Analysis and Learning from Experiences
Analysis and learning from experiences are integral parts of ongoing work within the healthcare sector. When results are utilized to understand what contributes to safety, sustainability, desired flexibility, and favorable outcomes, the organization can evolve to enhance quality and safety while reducing the risk of healthcare injuries.
The outcomes of hip and knee prosthesis surgeries are monitored through the Swedish Knee Register, in which the Joint Replacement Center participates in data collection. The annual report for 2023, published on August 29, included a selection of patients who were operated on during the organization's first year. One of the quality parameters that indicates the organization's patient safety is "reoperations within 2 years." This data is published separately for hip replacements and total knee replacements. The report indicated that we had good results regarding reoperations for reasons other than infection. However, it was clear that we had a higher-than-average rate of reoperations due to infection compared to the national average. This confirmed findings identified through self-assessments at the end of 2022, which led to initiatives focused on infection prevention throughout 2023, as detailed above under Actions for Safe Care.
Record Review
Record reviews are conducted based on focus areas currently including dressing changes and blood glucose control during hospitalization, dressing changes within the first three weeks, perioperative body temperature, and tendencies for fainting postoperatively. There are plans to implement software that can simplify the process of extracting data from medical records.
Record reviews are also conducted for all significant complications. The purpose is to assess whether anything could have been done differently to prevent future complications. The cases are documented in a list within the medical records system to provide aggregated statistics and enable analysis of frequency, correlations with external factors, etc.
Guarantee Operations
Postoperative complications treated by another clinic within two years of the primary operation are reported and billed by the Stockholm Region, serving as an additional source of information.
Deviations
Deviations can be reported to the nearest supervisor, process manager, and in the unit's deviation management system. The aforementioned event analysis and deviations have generated lessons learned and new routines within the organization. Examples include:
Fainting Episodes: A new working method has increased the presence of staff in our bistro for quicker response when a patient faints during breakfast the day after surgery. This has reduced risks for the patient and enhanced patient safety.
Burns from Heating Blankets: The unit's heating blankets are not placed directly against the skin; instead, a sheet is placed in between as a barrier.
Inadequate Handover Reporting: To ensure that all patients are assigned a responsible nurse, the transferring nurse must report all admitted patients by systematically reviewing all patients listed on the nurse's station patient board.
Late Changes in the Surgical Schedule with Inadequate Communication: In the event of late changes to the surgical schedule, the responsible department head and the charge nurse on the ward must always be contacted to ensure that updated information is communicated to all affected staff members.
The management team, including the medically responsible lead physician and quality controllers, is responsible for continuously encouraging and training staff in deviation reporting.
Complaints and Feedback
Complaints and feedback primarily come in the form of direct responses during follow-up visits, but also via letters or phone calls. In cases where these have highlighted systematic deficiencies, they have been discussed in the management team and have led to adjustments in routines. One example is the inadequate telephone availability for patients, which has been addressed by providing more appointment times and introducing a secure app for asynchronous communication regarding common inquiries.
A few cases have been reported via the Health and Social Care Inspectorate (IVO). These have, without exception, consisted of perioperative and postoperative complications. These cases are primarily discussed among colleagues in relation to the incident and from a broader system perspective during management team meetings when relevant.
Enhancing Risk Awareness and Preparedness
Resilience in Healthcare Planning
All areas of healthcare must plan for a health and medical service that can flexibly adapt to both short-term and long-term changes in conditions while maintaining functionality, even under unexpected circumstances. In the context of patient safety, this is described as resilience.
As a relatively newly established clinic undergoing expansion, there is a natural and continuous need for planning to accommodate changing conditions. In the work related to recruitment, equipment procurement, and operational planning, resilience is considered a significant parameter.
In 2023, the Joint Replacement Center continued to expand. New workflows and routines were developed in response to increased patient inflow, and facilities were expanded. The organization’s resilience has been enhanced through ongoing recruitment, increased material volumes, and updated job descriptions.
Future Patient Safety Initiatives
To promote patient safety and minimize the risk of healthcare injuries, the organization actively works on developing the competencies of all workgroups to enhance both specialized and general skills within the clinic as a whole. In 2023, clinic staff participated in the following training:
Refresher training in Basic Life Support (S-HLR)
Fire safety procedures have been further established and made more accessible to all staff
In addition, the operating department completed mandatory radiation protection training in 2023.
The nursing department has focused on competency development in various areas during 2023 to promote patient safety. Examples include:
A wound care group was initiated with the task of developing an evidence-based wound care protocol for staff to follow.
Surgeons evaluate each other regarding postoperative imaging to monitor and further develop surgical techniques. This information is entered into anonymized statistics to allow for the evaluation of even minor details over time.
Goals, Strategies, and Upcoming Challenges
In 2024, the Joint Replacement Center will continue to work actively on patient safety across several different areas.
Goals
Total reoperations: < 1.0%
Deep infections: < 0.5%
Intraoperative fractures: 0%
Dislocations within 3 months: 0%
Revision of Unicondylar Knee Arthroplasty (UKA) to Total Knee Arthroplasty (TKA): < 1%
Dressing changes during hospital stay: < 10%
Medication errors: < 1% of hospitalizations
Unplanned healthcare contacts resulting from surgery within 3 months: < 5%
To facilitate quality control, a technical solution is being implemented. The purpose is to extract anonymized data from specific keywords in patient records related to quality parameters. This is expected to provide more reliable data and be time-saving compared to the current manual chart review process.
Analysis and statistics regarding cases with or without prior syncope will continue to be evaluated. A new approach is planned to determine whether certain cases can be prevented.
The Infection Prevention Group will continue its work by utilizing Care Bundles to identify areas for improvement and implement new practices aimed at preventing deep infections.
The Wound Care Group aims to initiate workshops on dressing changes to ensure all staff members work in a consistent manner.
Point prevalence measurements and improvement efforts regarding hygiene are planned, and a designated nurse responsible for hygiene has been appointed.
A dedicated plain X-ray unit will be operational this year. This enhances patient safety by allowing for quicker verification of implant positioning and the exclusion of intraoperative mechanical complications at an earlier stage. Direct feedback to the surgeon facilitates skill development and enables proper X-ray rounds within the collegium for independent quality control.
Medication errors will be minimized through updated standard prescriptions. A control system featuring repeated questions about allergies, for example, at multiple stages will enhance safety.
In addition, continued efforts are needed to increase the reporting of incidents and further raise awareness among staff regarding patient safety issues.
The onboarding process will be standardized to ensure that new employees receive a comprehensive introduction to the unit's routines, work methods, and various systems.
A need to address this year is the development of a better technical solution for retrieving and organizing data from the patient record system.