Orthopaedic Surgery

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Introduction

Orthopaedic Prioritisation Tool

This national tool ranks adult patients referred for publicly funded elective surgery.

Paediatric patients are not scored on this tool.

It should be applied to all patients who would consent to, and benefit from surgery, and for whom surgery is the most appropriate treatment option.

The score should be based on the considered clinical decision of the surgeon, incorporating the history, examination and relevant investigations.

Patients should be scored impartially.

The score should be calculated during the consultation, and the patient informed whether they will be accepted for publicly funded treatment.

Treatment of a condition may require a number of procedures to be sequentially performed. For the purpose of the priority access the procedures should be considered as one event and the score for the first procedure carried forward.

Special cases

Automatic Priority

An appropriate priority score reflecting the clinically appropriate timeframe for treatment will be automatically assigned for the following cases.

Prioritisation

Prioritisation of elective Orthopaedic surgery

Impact on Life
Surgeon Derived Impact on Patient
Likelihood that significant deterioration in symptoms/function will occur in the next 6 months
  • (≤ 25% i.e. little risk, stable condition or slow progression)
  • (25 - 75% moderate risk, condition has gradual and predictable progression)
  • (> 75% high risk, condition likely to have rapid or unpredictable progression)
Consequence (or significance) of deterioration in symptoms / function occurring in the next 6 months
i.e. increased/additional symptoms, further compromise of function, or increased complexity of surgery.
  • (change will have little impact on the patient or the surgery)
  • (change would have significant impact on the patient or the surgery)
  • (change would have a severe impact on the patient or the surgery)
Amount of benefit from the proposed surgery for this patient
  • (symptoms and/or compromise of activities – minimally improved)
  • (symptoms and/or compromise of activities – improved)
  • (symptoms and/or compromise of activities – markedly improved)
  • (return to near normal)
Risk of surgery for this patient - death or significant complications
considering anatomy, pathology, frailty, co-morbidities, past history (DVT/infection) , procedural complexity.
  • (>20%)
  • (6 - 20%)
  • (≤ 5%)
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