Patients Know Best (PKB) has been used by different Orthopaedic teams, from post-operative care, physio, pain and rheumatology teams for many years to better manage their cohort of patients.

With over 200 different musculoskeletal conditions and the current NHS waiting lists, orthopaedic patients are experiencing longer than usual waiting times for appointments, procedures and operations.

This deploy page will show you how different orthopaedic services can use PKB and features teams are already using with their patients.

Current problems

• Teams experience a high level of face-to-face appointments

• Telephone conversations are lengthy

• Teams want to give patients online resources to support self-management

• Teams want patients to have access to their blood results

• Teams want to enable digital consent

• Patients travel long distances for short hospital appointments

• Large waiting times, patient conditions can improve and deteriorate, meaning care and health needs change

• High DNA rates

PKB solutions

• A central, secure place for information and healthcare data to sit in the hands of the patient

• Empowers patients to contribute to their own goals and care plans

• Provides access to prevention and health promotion resources

• Access to management advice, with patients being fully involved in their care through shared decision-making and self-management

• Enhanced recovery care plans for elective recovery

• Supporting patients at home

• Universal messaging, the ability for patients and teams to send messages in a timely, flexible way and all in the patient's record

PKB features

There are key PKB features all orthopaedic services can use with their patients to support them while they wait, both preop and post-operatively. A list of them is below.

Care plans

PKB care plans can be used at every stage of a patient's condition journey, below are some of the care plan templates being used and templates that can be created.

• Living Well for Longer

• Condition information and resource care plans

• Orthopaedic monitoring condition plan here is an example of a cardiology monitoring care plan

• Mental health wellbeing information and resource

• Rehab, physical activity and musculoskeletal health

• Goals setting care plan

• Generic support care plans from physiotherapy, podiatry, occupational therapy, orthotics teams

• 8-Week Orthopaedic Prehabilitation plan

• ACL Reconstruction Proforma care plan

• Enhanced recovery care plan

• Peri-operative care plans

Osteoarthritis Care Plan Template

There are a number of other orthopaedic care plan templates that have been created for teams, a list of them are below. If you would like to see them in full please ask your Success PM.

Consultations

PKB allows patients to complete any forms, surveys or questionnaires (collectively called 'Consultations'). Consultations can be sent on an individual basis or sent to a whole cohort of patients. The output of the consultations can be aggregated and anonymised and is available via the API or as a CSV download.

Teams can get patients to fill in consultations periodically, in some cases these are pre-appointment or post-operative assessments. Below are some of the consultation templates being used by teams.

• Annual Review and Flare-Up questionnaires

• MSK-HQ short questionnaire

• Symptoms and quality of life questionnaire

• PREOM

• Pain questionnaire

• Enhance recovery after surgery questionnaire

Benefits

• Individualised care plans

• Appropriate resource library specific to the patient’s condition

• Timely and flexible messaging between patients and team

• Digital appointment letters and appointments

• Access to laboratory results

• Symptom and measurement tracker

• National quality of life questionnaires

• Digital consent

• Completion of consultations and PROMs

• The ability for hospital PAS to add patients to the relevant team in PKB (i.e. pain/surgical/rehab team)

Example Goal for using PKB

Reduce the number of patients not attending appointments (DNA) of the rheumatology team by Sept 2023 (12 months post team go live) from (current DNA rate) to ( %) by sending all appointment letters and appointment details into PKB instead of by post. Current DNA rates are (%). 12 months post go live, the team compare DNA rates of patients with and without a PKB record. It is a local NHS priority to reduce DNAs to save money.

Workflow for Orthopaedic patients

The workflow below shows how PKB can be used in preop and post-operative assessments by giving patients access to their PKB record using the care plan and consultation functionality.

Workflow for orthopaedic consent

Teams can use the care plan feature to gather informed consent before operations and procedures. This workflow diagram below shows how teams can send the consent care plan to their patients to look over and sign before they come into the clinic/hospital. For more information on how PKB manages consent please click here.

Use cases of PKB

The below examples show how PKB is being used in orthopaedic services, if you would like to know more about these teams and want to start using PKB in your service please speak to your Success PM or look at our case studies here for more examples of how PKB is being used in other specialty areas.

Rheumatology

• PKB making a big difference to rheumatology patients in Swansea Bay services by giving patients access to their blood results and clinical documents

• Giving different Allied Health Professionals the ability to access patients' records to provide a holistic care approach to patients within the Rheumatology Department. By educating patients, the team want to reduce the number of unnecessary contacts via the Advice Line and to allow virtual clinics to avoid the need for a patient to attend the clinic or even require a telephone call.

The Persistent Pain team at Hywel Dda

• The team are working with patients with Osteoarthritis and Fibromyalgia as part of a study to see how the use of a PHR helps improve patient outcomes. The team are using consultations and library resources to support patients living with long-term pain. This includes access to resources about their condition, exercises, sleep hygiene, goal setting and the ability for patients to upload their own health data such as measurements, and to respond to questionnaires.

Physio team

• Using PKB to provide resources via the library for patients discharged without follow-up and for patients on a 6-month PIFU 'discharge' with a shared care plan, library resources, questionnaires and team messaging.

Further information

• 8-Week Orthopaedic Prehabilitation Plan: preoperative care plan

• Consent care plan templates: how to do informed consent through a PKB care plan before surgery

• ACL Reconstruction Proforma care plan template: enhance recovery care plan for orthopaedic patients in hospital and post-discharge

• PKB making a big difference to rheumatology patients: giving patients access to their blood results and clinical documents

• Pre-clinic consultation: (coming soon)

• Peri-operative specialty team: how PKB can be used pre and post-operatively

• University Hospitals of Derby and Burton NHS Foundation Trust Dermatology: Using messaging and pre-appointment consultations to decrease the number of phone calls, saving both patient and clinician time.