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EC Objective 2: Develop Clinical Protocols to reduce variability in delivering care

Evidence-based Clinical Protocols for diagnosing and treating patients form an essential part of a practice’s
quality and efficient care. Protocols are care pathways that physicians should utilize as a guideline to
reduce variability in care and provides consistent best-in-class care.

The use of clinical protocols does not replace physician expertise and judgment on a case by case basis,
which will always be essential, but the proper use of protocols reduce unnecessary care variability.

Successfully applied Clinical Protocols require physician leadership and a strong multidisciplinary team.
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It has been shown that clinical protocols improve patient outcomes while increasing physician efficiency.
SUL has committed to developing and maintaining clinical protocols to ensure the best possible outcomes
for our patients.

Clinical Protocol Example: Day Versus Inpatient Surgery. An example of a protocol focused on more efficient and effective care, our Day versus
Inpatient Surgery protocol is detailed in Figure 2 in the back of this report.

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It has long been demonstrated that for certain surgeries, day surgery is safer and better for patients than the same surgery with a hospital stay.
Day surgery is not only safer, but it is also more efficient to the health system as a whole as patients would not unnecessarily occupy a hospital bed.
However, not all patients are suited for day surgery. Surgery as a day case also requires a very well managed process, which a clinical protocol
facilitates.

Since SUL surgeons believe that under the right conditions, day case surgery is more effective and efficient, we developed an evidence-based day
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surgery protocol to ensure that only patients who met our criteria would be eligible for surgery. Please refer to Figure 2 at the end of this report
for this protocol.

Table 5 on the next page illustrates the percentage of SUL cases that were done as day surgery.

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Hurwitz SR, et. al “Orthopaedic information mastery: applying evidence-based information tools to improve patient outcomes while saving orthopedists’ time. J. Bone Joint Surg. 2000;82(sup
pA): 888-894.
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Daniel J Quemby MBBS(Hons) BSc(Hons) BSc Med Sci, MIBiol MRCS FRCA, Mary E Stocker MA (Oxon) MBChB FRCA , “Day surgery development and practice: key factors for a successful
pathway”, Contin Educ Anaesth Crit Care Pain, Dec 5, 2013.
9 “Model of Care for Elective Surgery: Improving the Patient Journey National Clinical Program”, Health Service Executive Royal College of Surgeons in Ireland, College of Anesthetists of Ire
land, 2013.
The Shoulder and Upper Limb Unit