title: Documentation in orthopaedic surgery - do integrated care pathways work?
abstract: Integrated care pathways (ICPs) are being widely adopted in orthopaedic surgery. This study compares the quality of medical notation in an ICP with traditional record keeping. During a 3-month period, 53 total hip replacements (ICP notation) and 30 total knee replacements (traditional notation) were performed. The records of each patient were scrutinised using a standardised scoring system, based on The Royal College of Surgeons of England guidelines on medical record keeping. Each set of records (83) was scored for: admission clerking, subsequent entries, consent form, operation note, and discharge letters. The time taken to retrieve this information was recorded. The overall score for traditional records (mean, 70%) was significantly higher (P = 0.001 ) than for the ICP records (mean, 62%). The mean scores for initial clerking, subsequent entries and consent form were higher in the traditional record group. It took 35% longer to retrieve information from the ICP group (P < 0.001). In this study, the quality of record keeping was higher when using the traditional notation than an established ICP. In both groups, the frequency of omissions was high.
authors.affiliation: Department of Trauma and Orthopaedics, The Ipswich Hospital, Ipswich, Suffolk, UK. jrcrawford@doctors.org.uk
authors.forename: John R
authors.initials: JR
authors.lastname: Crawford
authors.forename: Michael
authors.initials: M
authors.lastname: Shanahan
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D004282:Documentation / Q000592:standards*; D004739:England; D006801:Humans; D008499:Medical Records / Q000592:standards*; D009985:Orthopedics / Q000592:standards*