The Royal Orthopaedic Hospital | Bone Infection Unit referrals | Updated 23/12/19

The Royal Orthopaedic Bone Infection Service will accept referrals for the investigation and treatment of prosthetic joint infection. 

This is a weekly MDT meeting with specialist revision surgeons and infection specialists. Urgent referrals should be discussed directly with the appropriate on-call team

Please complete all Prosthetic Joint Infection Referrals via www.referapatient.org

SUMMARY

  • The service consists of a multi-disciplinary team with arthroplasty and oncology orthopaedic surgeons supported by infectious diseases, microbiology, antibiotic pharmacists, specialist nurses, plastic surgeons and tissue viability nurses. Patients within the region can often be supported at home after treatment by a dedicated orthopaedic community care team

 

  • All referrals are typically discussed in a weekly multidisciplinary meeting and seen in a suitable outpatient clinic. 

 

  • The multi-disciplinary team assessment will rely on a detailed summary of the patient’s previous orthopaedic surgery, microbiology (in particular any drug resistant bacteria), soft tissue assessment, details of co-morbidities and/or immunosuppression and medical treatments.

 

  • It is important to detail the patient’s ideas, concerns and expectations regarding their management.  

 

  • If the referral is incomplete it may delay our assessment. Any proposed surgery will require an assessment of suitability by the anaesthetic team.

 

  • Referring hospitals must repatriate patients after acute intervention within 24 hours of request for repatriation.

We do not accept referrals simply for antibiotic treatment.

Blood tests and pertinent radiology should be included.


All referrals are TYPICALLY discussed in a weekly multidisciplinary meeting and seen in a suitable outpatient clinic.


 

We cannot accept referrals regarding acutely septic or unwell patients. Any urgent surgery remains the responsibility of the local orthopaedic team.  

Please complete all Prosthetic Joint Infection Referrals via www.referapatient.org

Please note that long bone, skull base or diabetic foot osteomyelitis should follow different referral pathways.

Referrer Obligations

The referring unit must ensure that:

  1. The patient is reviewed and referred by registrar grade or above and discussed with the supervising consultant.

  2. The patient has been appropriately assessed and resuscitated from a general medical point of view.

  3. The patient has been physiologically assessed for suitability of transfer. 

  4. All appropriate initial imaging has been completed.

  5. All imaging has been digitally transferred to the appropriate emergency portal as directed by the ROH Bone Infection service.

  6. The referral is in a written format ideally in a digital form. 

  7. The initial management plans outlined by the accepting Bone Infection service are carried out.

  8. Any agreed transfer takes place rapidly and after ensuring the patient is fit for transfer.

  9. You agree to repatriate the patient when care is complete. Repatriation should occur within 24 hours of request and failure to repatriate should be escalated through to senior management.

Receiving Bone Infection Unit Obligations

The  service receiving the referral must ensure that:

  1. They provide a clear and available contact point for referrers.

  2. Any referral received must have been reviewed by registrar grade or above and discussed with the supervising consultant.

  3. Any digital or verbal referral is reviewed and an initial response given after the MDT meeting.

  4. There is a clear written protocol for image transfer available to the referring service that allows the receiving clinical team to access images to facilitate provision of advice.

  5. Clear advice is given outlining recommended action plan including plans for medication, mobility status, orthotics, further imaging and transfer plans. The advice should be written and ideally in a digital format that the referring hospitals can access.

  6. Any agreed transfer takes place expediently and on the agreed day. The referring hospital must be updated if transfer does not happen on the agreed day. Failure to transfer should be escalated through senior management.

  7. Any patient ready for transfer must be assessed and documented as fit for transfer.

  8. On repatriation or discharge, a written discharge summary must be provided to the referring service with a clear outline of management undertaken, orthotic advice (if appropriate), wound management (if appropriate) and a rehabilitation prescription. Clear follow up instructions should be given.

  9. All postoperative imaging is provided to the referring centre.

  10. There is continued access for advice as required.

The Royal Orthopaedic Bone Infection Unit
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