Minimise Risks in Hip Replacement Surgery

The demand for hip replacements in the private hospital sector in the UK has surged in the past few years. Laing Buisson, healthcare analysts, recently reported that for the first time since 1948, the private sector is set to perform more knee and hip replacements than the NHS.

This short document is designed to assist surgeons to mitigate the risks associated with hip surgery, minimising the risk of litigation, and enhancing patient safety.

Risk management strategies

1. Training and performance improvement

• Consultants should engage in performance improvement opportunities and peer review activities to enhance technical surgical skills, ensure competency and improve performance and quality.
• In order to standardise processes, improve efficiency, and support quality of care, clinicians should follow evidence-based guidelines and clinical pathways.

2. Informed consent

In accordance with the GMC’s Decision making and consent, clinicians should ensure they have a meaningful discussion with the patient prior to any procedure to enable the patient to make an informed choice. This should include details of the surgical procedure, risks, benefits and alternatives. In addition, consider what is most important to the individual patient, taking into account their lifestyle and employment.

• Provide information leaflets and consider directing the patient to useful websites.
• Try to make sure that the information shared with patients about the options for treatment is objective.
• Document in detail the content of your discussion in the patient’s medical record.
• On the day of admission, recheck the patient understands the intervention and allow time for any further questions. Document this discussion in the patient’s record.
• Provide the patient with a consent form to sign, detailing the procedure and the associated risks and benefits.
• Keep a copy of the consent form in the patient’s medical records and provide the patient with a copy.

3. Communication

• Communicate adequate, clear, and appropriate information to patients.
• Use layman’s terms when talking about procedures, treatment plans, anticipated benefits, potential risks, and alternative therapies.
• Provide patients and families/caregivers with appropriate education and instructions prior to discharge.

4. Funding

• If the patient is self-funding, provide them with clear information about all the costs involved, including those associated with post-operative follow-up.
• Ensure the patient is aware of their right to a refund or return of deposit if they change their mind about the proposed treatment.

5. Surgery

• Conduct thorough pre-procedure screening for risk factors.
• Ensure that all appropriate health information for each patient is available prior to the start of a procedure.
• Ensure all necessary equipment and supplies are inventoried and verified prior to the start of a procedure.
• Ensure the site of surgery is marked and involve the patient in the process.
• Ensure strategies are in place to minimise team communication breakdowns and encourage team members to speak up about safety concerns.
• Participate in surgical team timeouts prior to the commencement of surgical procedures and completion of the WHO Surgical Safety Checklist.
• Avoid implant selection errors with the introduction of intraoperative ‘stop moments’ before implantation and before wound closure. This will provide an opportunity to check all implant details and ensure the compatibility of each component.
• Follow the recommendations in the NICE guideline on the prevention and treatment of surgical site infections.
• Carry out consistent post-procedure assessment processes.

6. Handover

• Allow adequate time for handover, prioritising tasks and plans for care and review of unstable patients.
• Ensure any post-operative deterioration and/or complications are communicated, investigated and managed in a timely and appropriate manner.
• Record details in the patient’s medical records.

7. Duty of candour

• If the patient experiences an adverse outcome, it is important to investigate, explain and apologise to the patient. For further guidance on your ethical obligations, please refer to GMC guidance, “Openness and honesty when things go wrong: The professional duty of candour”.
• If you receive a complaint from a patient or a patient suffers an adverse event, please call the PMP medicolegal helpline as soon as possible, details can be found on your policy documents. The helpline can assist customers to prepare an appropriate response.

8. Learning from events

An adverse event whilst distressing should be used as an opportunity to reflect, learn and adapt changes to a clinician’s practice and ultimately to improve care.

9. Record keeping

• Maintain clear and accurate medical records.
• Document a complete, concise, and accurate operative report on the day of each procedure. Ensure the entry is dated, timed and signed.
• These contemporaneous records will form the basis of any medicolegal defence, should this be necessary.

10. Professional indemnity insurance

• Ensure you have adequate professional indemnity insurance in place to cover all the procedures and interventions you undertake. It is your responsibility to inform your indemnity insurer of any changes to the scope of your practice.