20 years of the National Joint Registry
Published: 02 Mar 2024
How the NJR benefits hospitals
The National Joint Registry (NJR), which is hosted by HQIP, was founded in 2002 and started collecting data to monitor the performance of hip and knee replacement surgery in England and Wales in 2003. Since then, they have expanded their scope of both joints and territories covered. Elaine Young, Chris Boulton and Deirdra Taylor from NJR’s Management Team, explain more about the Registry’s interactive reporting tools and the benefits they offer to hospitals…
The NJR has invested in the development of a wide range of interactive reporting tools over the years for both hospitals and surgeons. Most of these can now be accessed through our dynamic software reporting platform NJR Connect – Data Services, which includes Annual Clinical Reports on joint-related procedure performance outcomes.
Supporting best practice
We support local clinical governance through the provision of hospital- and surgeon-level reports, providing an independent assessment of the safety and effectiveness of local practice compared to national benchmarks. We alert hospital Medical Directors of any adverse patterns in patient outcomes attributable to their hospital and provide data and analysis to support local investigation of root causes for raised alerts. In 2022, we launched the NJR implant scanning app to support medical device implant checking during an operation, to help prevent the occurrence of ‘never events’ where incompatible implants are inadvertently used in patients. Every six months, a comprehensive analysis is undertaken of the performance of all surgical units undertaking joint replacement in the NJR’s operational areas. Each hospital, regardless of their performance, receives a comprehensive in-depth analysis of their practice, including a list of all revisions and deaths. This regular reporting mechanism enables hospitals to reflect on best practice and address any issues relating to worsening outcomes.
Regular reporting mechanism enables hospitals to reflect on best practice and address any issues relating to worsening outcomes
NJR annual clinical reports (hospital-level reports)
Annual Clinical Reports are provided for all hospitals submitting data to the registry, enabling a detailed analysis of activity and outcomes across joint replacement services. This also provides Medical Directors with a summary of the performance outcomes for each surgeon operating in their units. This is supplemented by analyses that provide indications for revision across their hospital so that trends can be identified, in addition to a summary of how individual surgeons are contributing to a hospital’s overall outcomes. This data is supplemented by customisable reporting tools within our NJR Connect platform, as well as a detailed appendix of individual patient outcomes, which means that data can be analysed locally. In summary, key benefits include:
- The ability to monitor and identify ‘never events’ such as use of the wrong implant, or wrong body side (and increasingly prevent them from happening with use of the NJR scanning interface).
- Poorly performing units and surgeons are identified and supported to improve.
- Poorly performing implants are identified and this information is escalated to regulators.
Example extract from NJR Management Feedback reporting function in NJR Connect – Data Services
Price benchmarking
With a view to improving the cost effectiveness of joint replacement surgery, the NJR’s implant price benchmarking service gives hospitals the information they need to benchmark the price they pay for hip, knee, ankle, elbow and shoulder implants against the ‘best’ national prices achieved across all hospital implant procurement services. This service enables hospitals to drill down into their pricing data, including the additional capability to give surgeons individual reports relating to their own implant use. The NJR’s enhanced implant price-benchmarking service, EMBED, supports hospitals to understand, in greater detail, their use of joint replacement implants in terms of cost, evidence and trends in comparison to the national picture. This service provides clinicians, management, procurement and finance teams with an objective set of data and analysis to inform their decision-making. With a focus on cost and value alongside procedure outcomes, it also underpins the Getting It Right First Time (GIRFT) and NHS England’s Model Health System initiatives.
A sample of the EMBED price bench-marking report
Shared decision-making in a clinical setting
Patient information and knowledge is vital for hospitals to ensure understanding, confidence, manage expectations and contribute to shared decision-making. We publish hospital-level information about patient outcomes following joint replacement surgery that enables patients to understand what to expect from their treatment and to inform their decision about where to be treated: The National Joint Registry – Surgeon and Hospital Profile (njrcentre.org.uk).
We also produce guidance from NJR’s Annual Report to provide patients with digestible data on the type and quality of joint replacement surgery undertaken, to increase patient awareness and patient choice: The National Joint Registry reports (njrcentre.org.uk).
The NJR patient support tool
Additionally, the NJR Patient Decision Support Tool is a freely available online tool that was developed using NJR data on hip and knee surgery, to help those considering joint replacement surgery to better understand the risks and benefits of having a hospital procedure. The patient enters simple details such as age, sex, height, weight, general health and how their joint disease affects them. The tool then uses NJR data from similar patient experiences to calculate how much better the patient will be likely to feel after surgery. The tool also calculates the risk of death after surgery, as well as the likelihood of repeat surgery being needed. Patients with a better understanding of their surgical procedure, their own risk level, and what will be happening to them are likely to be better prepared for their hospital procedure and to thereafter have better outcomes. The Patient Decision Support Tool is an example of how both patients and surgeons can make informed decisions jointly in their hospital consultation time, as an important part of patient-centred medicine. Developed as part of NJR’s supported research programme, it has been accessed by many tens of thousands of patients across over 110 countries to better understand their risks and benefits before surgery. With this brief overview, we hope we have given a flavour of some of the benefits that the NJR delivers to hospitals. By recording, monitoring, analysing and reporting on performance outcomes in joint replacement surgery, we are committed to supporting a continuous drive to improve service quality and enable research analysis – and, ultimately, improve patient outcomes.
About the National Joint Registry
Described as a global exemplar of an implantable medical device registry, the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man and Guernsey continues to be the largest orthopaedic registry in the world, with an international reputation and over 3.7 million procedure records submitted. They collect information on hip, knee, ankle, elbow and shoulder joint replacement surgery and monitor the performance of joint replacement implants.
More information: www.njrcentre.org.uk
This article was originally featured in HQIP’s quality improvement magazine, CORNERSTONE – to see more articles on topics such as healthcare inequalities and sustainability in healthcare, go to: www.hqip.org.uk/wp-content/uploads/2023/11/HQIP_Cornerstone_2024.pdf.