Clinical audit - UDOTS

Our core function is to work in partnership with NHS Tayside to manage major long-term outcome studies.

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Tayside Orthopaedic Clinical Audit (TOCA) is a collaboration between the NHS and the University Department of Orthopaedic & Trauma Surgery (UDOTS), to evaluate the outcomes of orthopaedic interventions.

The University team is supported by NHS Clinical Audit Facilitators in various hospitals locally. Clinical and patient outcome information for orthopaedic surgical interventions and conservative treatments help us to evaluate the success of the different types of treatments we offer, to monitor complications, revision rates and assess patient satisfaction. The information can be utilised to develop clinical pathways. The data can also be valuable for analysing in School of Medicine research studies.

Current studies

Tayside upper limb audit

This evaluates the outcome of specific upper limb surgical procedures performed in Tayside. These include shoulder stabilisation, subacromial decompression, rotator cuff repair, hydrodilatation, capsular release, acromioclavicular joint excision and reconstruction and shoulder and elbow arthroplasty. The patient-related outcome measures (PROMs) used are the EQ-5D-3L, Oxford Shoulder Score, Oxford Shoulder Instability Score, Oxford Elbow and QuickDASH. Arthroplasty surgery is followed up annually for 5 years then again at 10 years.

Spinal surgery audit

This evaluates the outcome of spinal surgery performed in Tayside utilising the following scoring systems: EQ-5D-3L, The Visual Analogue Scale (VAS) Pain Score, Neck Disability Index, Modified Japanese Orthopaedic Association Scoring System and the Oswestry Disability Score.

Hip and knee arthroplasty audit

For over 25 years Tayside has collected outcomes data to monitor the performance of implanted medical devices. Tayside Arthroplasty Audit Group (TAAG) provides a mechanism for monitoring the outcome of arthroplasty surgery. All patients admitted for primary total hip arthroplasty, primary total knee arthroplasty, hip resurfacing, uni-compartmental knee replacement, revision hip and revision knee surgery are encouraged to participate. Baseline information is collected by independent clinical audit practitioners (trained physiotherapist or nurse) in each participating Centre in Tayside (Stracathro Hospital, Ninewells Hospital, and Perth Royal Infirmary). Patients are then followed up according to the study protocol.

The Harris Hip Score (HHS) and Knee Society Score (KSS) are used as standard outcome measures. Short and long-term complications are recorded as well as patient satisfaction. Any highlighted problems are fast-tracked back to the operating consultant. Local performance benchmarks have been agreed upon by the TAAG steering group. The TAAG steering group consists of the Clinical Director of the Tayside Orthopaedic Unit, the Clinical Governance Chairperson, and the Clinical Audit Services Manager.

Soft tissue knee audit

This evaluates the outcomes of specific soft tissue knee procedures, in both adults and children, performed in Tayside. The procedures include ligament surgery, patella tendon surgery and cartilage surgery. The validated PROMs used are the EQ-5D-3L and the knee Injury, KOOS child and Osteoarthritis Outcomes Score.

Foot and ankle evaluation programme

This evaluates the outcomes of all elective adult foot and ankle surgery and selected conservative treatments performed in Tayside. From late 2020, paediatric cases have been included in the audit. The validated PROMs used are the EQ-5D-3L, Manchester Oxford Foot questionnaire, Oxford Ankle and Foot questionnaire for children and PROMIS.

Non arthroplasty hip evaluation programme

This recently commenced in response to specific surgeries requiring close monitoring, such as peri-acetabular osteotomy, now being performed in Tayside. The Proms used for these surgeries are EQ-5D-3L, iHOT and the modified Harris Hip Score (mHHS).

Audit process

For the PROMs based audits, all patients are invited to participate by completing questionnaires pre-operatively, at 6 months and 1 year and then yearly to a maximum of between 2 and 10 years depending on which audit and type of intervention.

All of the audits involve the collection of basic demographics, diagnostic and operative information along with any complications and revision information. The surgeons have access to a live reporting system where they can see their results and receive individual feedback, along with group feedback. These programmes identify trends and outliers. An outcome predictor tool has been developed for patients undergoing common foot and ankle surgeries.