Medical practice is an ever- evolving field: paradigms change diametrically. For example, timely operations, which were previously thought very dangerous, helped save millions of lives in vehicular accidents. Every treatment for every condition has a recognized proportion of risk, side effects and complications. New discoveries and innovations to better existing methods of treatment are also continually being developed. When our near and dear ones require treatment, we obviously want them to have the best quality of care and also the least risk. The term ‘Centre of Excellence’ (CoE) applies to any field. With medical specialization, the establishments which have pioneered particular treatment methods and/ or proved to effectively benefit patients have become guiding examples for other such treatment facilities around the world to follow.
How do patients benefit from treatment at a CoE?
New innovations to treatment almost always sound very promising. However there could often be new side effects and different complications that have not been seen with the older time- tested methods. Hence it is recommended by governing bodies that new innovations go through a controlled trial process in the initial experimental stage. Systematic processes to regulate novel treatments don’t exist in every country and the guidelines are not legally binding for every specialty or type of treatment. Hence novel things are often marketed using lower quality scientific evidence to woo the customers.
When a particular person seeks information about a new type of treatment on the internet, they are at the receiving end of an ocean of information that sounds convincing but may not be scientifically verified too. While innovation is obviously good, the onus is on the patient to choose and submit themselves to what they think best.
The ideal solution is a treatment centre where patients can be educated regarding options of treatment available for their ailment and guided on making their choice on the basis of scientifically well- proven methods.
Any hospital facility cannot proclaim to have achieved a ‘Centre of Excellence’ status overnight. It must have built up it’s own credibility over time and show that outcomes of patients treated there are comparable to the best in the world.
Why a CoE for Hip & Knee?
Replacement surgeries for the Hip & Knee joints have achieved very good success worldwide and even been ranked as number one and number three amongst all surgical treatments in terms of enhancing quality of life for patients. Hip & Knee surgeries are also very streamlined procedures. However, more than two thirds of joint replacement op[erations worldwide are undertaken by general orthopaedic surgeons, and not those who undertake exclusive specialist Hip & Knee work. Surgeries are undoubtedly costly and hence subject to marketing strategies from health service establishments where cost cutting is the main goal. As a result, it is difficult to guarantee that the best standards will be adhered to when the technical ability and billing at different setups is taken into account.
Centres and teams that work exclusively for Hip & Knee procedures are more likely to focus on recommended standards and have less chances of errors as well as complications. Knowledge in the entire field of orthopaedics is now so vast that it is impossible for practitioners to manage nuances of sub- specialties and also to provide state of the art standards in all. Most practitioners hence limit to some fields and provide basic levels of care in those. The exclusive focused centres however would be in a capacity to prove all- round treatment including complexities in the particular specialty.
What comprises a CoE?
It is very important to recognize that a single person cannot provide care from start to end and that comprehensive treatment can come from a coordinated team effort where different disciplines are involved. Every human being commits errors. The team ensures that shortcomings of each other are addressed in a joint effort where the combined goal of safety and quality of treatment to the patient is ensured. The different roles played in a Hip & Knee CoE are:
Examination and Counselling:
The patient suffering from the ailment needs a non- hurried and non- biased listener who then examines them and then correlates with x-rays or scans following which best treatment options are considered. It is wrong practice to see reports and dictate treatment. The opinions of the patient should be respected and the best treatment then explained in detail, often with the help of printed material, videos and so on. The patient must also be given time to consult family/ friends and ask questions so that they fully comprehend. This ensures that patients cooperate with their treatment.
‘Comprehensive: Preservation to Replacement’:
The team of different practitioners seeing the patient ensures that there is no bias towards either surgery or for medicine related cures. What is in the best interest of the particular patient should be followed exhaustively. If a patient can be cured without operation, there will be different options and methods that ensure cure with the patients’ whole hearted participation and the appropriate specialist for that method of treatment. Similarly, within operative treatments, there are choices of minimally invasive surgery without metal implants that can regenerate cartilage and cure early stages of arthritis in young patients. Novel innovations in cell therapy are diverse, but a CoE would be in the best position to employ the latest technology appropriately.
Co- ordination of patient pathway:
During admission for planned surgery, it is natural for patients to be anxious. This can be allayed to a great deal by effective planning and communication. Similarly preparation for surgery, waiting times, education about what will happen post- operatively until smooth conduction of the discharge process including appointment arrangements for review in the subsequent period are vital.
Execution of treatment:
Whether it is surgery or not, all treatments must be of high and tested standards, and safety must be ensured both in the out- patient setting and for patients admitted. This is done by getting patients to interact with others having similar conditions so that they can help each other emotionally when required. Such group therapy has shown to produce better results. It also works more economical to patients.
Rehabilitation:
In case of Hip & Knee planned surgery, exercises start before the operation and ensure fewer complications. Following surgery, these continue and are monitored on a time to time out- patient basis until the patient achieves full recovery and walks normally.
Evaluation of service, Research and Innovation:
No CoE can exist without having feedback of it’s own functioning. Feedback is not only of the patients’ subjective feelings about their treatments, but incorporates review of performance of all members of the team on objective parameters related to patient outcome results. Data obtained is compared with that from the best such centres in the world.
Similarly, every CoE should have their own contribution to betterment of treatments worldwide and internationally accepted scientific publications.
KMC Hospital, Ambedkar Circle, Mangalore is 250 bedded and caters to all multi- specialty facilities. We inaugurated an exclusive “Comprehensive Centre for Hip & Knee care” which is the first of it’s kind in India to be recognized for care for the entire spectrum of Hip & Knee joint ailments: non- operative and joint preservation treatments to complex joint replacement. The basic purpose therefore of having a planned surgery is to have a better quality of life subsequent to it. Ours being a ‘comprehensive leading edge centre’, we aim chiefly to nullify complications related to operations and have published our consistently excellent results as “Performance Indicators”. Similarly, we have made some innovations that have been scientifically tested and approved by international standards.
