Paediatric Orthopaedics - 2017 DRAFT

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Introduction

Paediatric Orthopaedic Prioritisation Tool

This tool is in DRAFT and only to be used in Trial – for clinical prioritisation decisions please use your current nationally agreed tool.

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

Adult 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 Paediatric Orthopaedic surgery

Impact on Life
Surgeon assessment of current functional loss and pain
This is not a measure of the pathological severity of the condition.
Likelihood of significant deterioration in symptoms/function or progression as a child
  • (≤ 10%)
  • (11-50%)
  • (> 50%)
Likelihood of significant deterioration in symptoms/function or progression as an adult
  • (≤ 10%)
  • (11-50%)
  • (> 50%)
Consequences of deterioration in symptoms/function
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
The expected amount of benefit considering both the effectiveness of the procedure and individual patient characteristics that might affect the outcome.
Relative risk of surgery for this patient - death or significant complications
Considering pathology, anatomy, procedural complexity, co-morbidities, frailty, other syndromic features etc.
  • (> 20%)
  • (6-20%)
  • (≤ 5%)
Window of opportunity
Greater benefit to be had or less complex operation required if the surgery is performed within the window of opportunity.
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