Tackling efficiency in a high demand orthopaedic clinic.

BACKGROUND: Surgical outpatient clinics continuously face challenges in delivering efficient and effective care. An expanding population and chronic staff shortages makes sustainability critical. The primary objective of this study was to identify modifiable factors contributing to longer wait times in an orthopaedic outpatient clinic. METHODS: A single-centre prospective observational cohort study was conducted at Western Australia's state trauma centre. Over a four-week period, clinicians completed forms identifying delays in clinic, and clinic numbers were captured through an electronic booking system. Data was analysed using SPSS v27. RESULTS: Face-to-face (FTF) and telehealth (TH) clinic volumes grew by 18.9% and 361.1% respectively between 2018 and 2022. For the study period, 754 forms were completed for attending clinic patients. This captured 42.4% and 96.8% of FTF and TH actual attendance. The average wait time for doctor consultation was 63.9 min. Wait times significantly reduced when x-rays were performed prior to clinic (P < 0.001), and when an unaccredited registrar held the on-call phone (P < 0.001). Trauma clinics ran overtime in 95% of cases compared to elective clinics in which 25% ran overtime. The golden staffing ratio was one doctor for 13 patients. TH experienced few delays related to technological fault. CONCLUSION: This study demonstrates that clinic volume continues to rise. It highlights the demand for adequate staffing and identifies several modifiable factors that influence clinic efficiency. It demonstrates the growth of TH as an alternative modality for outpatient surgical services and its potential for future expansion.

Training models for meniscal repairs and small joint arthroscopy.

BACKGROUND: The reduced availability of human cadavers and their associated high costs, coupled with an increasing requirement for meeting continuing professional development targets, has accentuated the need for alternative training models that meet current ethical standards. The aim of this study is to identify suitable substitutes that are accessible and cost effective for use as training models for meniscal repairs and small joint arthroscopy. METHOD: Ovine, bovine and porcine stifles were analysed for comparable anatomy to the human knee, arthroscopic access, arthroscopic view and ease of meniscal repair. RESULTS: The bovine stifle joint was found to be too large and offered limited access due to a large anterior fat pad and thick surrounding soft tissue. The ovine and bovine stifles were both easily available and had comparable anatomy to the human knee. Advantages of the porcine stifle include better availability and easier accessibility, comparable anatomy to the human knee and its relatively larger size that made it easier to arthroscope. CONCLUSION: Porcine stifles are cost effective, accessible, allow for meniscal repair and are suitable for arthroscopic access and view. Our view is that they are an ideal training model for arthroscopic meniscal repair, small joint arthroscopy and anterior cruciate ligament reconstruction.