Kawitsara Eumbannapong

Vision

The Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, is determined to achieve orthopaedics excellence across all areas from teaching and studies to research, academic advancement and quality services at both national and international levels.

Mission

Produce quality medical graduates, specialists and researches in orthopaedics, create enhancing academic environment and provide high quality, world-class othopaedic medical services that best address demand in the country while strengthening public trust and faith in the department and its people as well as guiding the society towards good health and hygiene related to orthopaedics.

Located at Sayamin Building, 1^st Floor, Room 104, the Orthopaedic Monitoring Unit is manned by eight nurses, 14 nurse assistants and five general officers. It offers medical services to both inpatient and outpatients with bones, joints, muscles, tendons and nerve problems, both inborn and not inborn. The unit focuses on postoperative orthopaedic patients care, screening patients for faster examination and no complication. Every day, 6-10 orthopaedic medical team and specialists are on duty to ensure fast, accurate, safe and reliable services that will ensure patients’ satisfaction.  Another major task of the unit is to promote health by educating patients on how to behave and take good care of themselves, providing information on surgery details and costs and room booking.  The Unit also serves as the center for normal bed management and special clinic after hours every Monday to Friday from 16.00-22.00  hrs and Saturday from 7.00-18.00 hrs. For special rooms, the unit will handle booking and management of rooms for patients who have surgery after work hours. In addition, the unit helps prepare patients for surgery, lab tests and appointment for specific disease examination, and provides them with information on their rights, costs and other related information before they are admitted. The unit also distributes prosthesis and orthosis for general patients and handle body jacket for other patients.

The unit cooperates with all related organizations, such as the Orthopaedic Surgery Unit, Sayamin Building 3^rd Floor, Pre and Post Operative Monitoring Unit, Orthopaedic Surgery Patient Wards, other patient wards, pharmaceutical department, Diagnostic Imaging Center, etc. With good cooperation with those units, patients receive fast service and treatment or surgery is confirmed without postponement or cancellation. On each day, it provides services to 90-290 outpatients, most are the elderly or those with pathological condition, or those coming for post-operative follow-up. These patients have risks of falling and injury. Considering this risk, the unit adopts various strict measures to ensure the highest patient safety. Nurses continuously monitor, assess, screen for risk and critical conditions. A special area is allocated for patients on wheel chairs and stretchers and patients using wheel chairs and stretchers must always be accompanied by family members. Wheel chairs and stretchers are kept in order. Floor is kept dry. For fast and convenient service, systematic patient appointment based on lean think concept has been implemented, which significantly reduces waiting time for patients. At present 70-90% of patients are on this pre-appointment system while 8-20% is walk-in patients.  According to our statistics, the top five groups of patients are those visiting hospital for F/U examination after surgery, F/U examination after treatment fracture, knee joint prosthesis, surgical dressing and suture and bone & tendon implant. Orthopaedic Monitoring Unitreceived Gold Star Unit Award 2013 and created many innovations such as “Heel Alert” or sponge heel in child’s cast and baby padding for hip spica.

The Orthopaedic Surgery Unit provides precise, efficient and safe orthopaedic surgery without complication. Surgery is generally done in cooperation with multi-disciplinary team members, including surgeons, residents, fellows, anesthesiologist, recovery room nurse, patient wards, X-ray officers, blood bank, Department of Microbiology, Department of Pathology and Siriraj Central Sterile Supply Department. The Orthopaedic Surgery Unit eight operating rooms and one septic operating room for patients with active infection problem.  In terms of nurse and nurse assistant manning, the unit ensures a good balance between workload and manpower. According to its 2014 productivity database, its average productivity is between 97%-118%. For extra hour special clinic, the unit offers four rooms and emergency surgery service by highly experienced team and with advanced technology and equipment. The unit has clearly set performance index according to the Department of Orthopaedic Surgery’sClinical Practice Guideline for 13 diseases (including clinical tracer for 10 discuses). To ensure that such guideline is updated, regular review by multi-disciplinary team is regularly held. This allows the unit to quickly detect and solve problems.

Knee replacement has been identified as the Area of Excellence at the Orthopaedic Surgery Unit and is comparable with the University Hospital Network (UHOSNET). The Unit has participated in the Siriraj Clinical Tracer Plus (SiCT+) organized by the Faculty of Medicine Siriraj Hospital since 2012. This will enable the unit to become a role model in treating patients with osteoarthritis of the knee. In 2014, the unit presented the progression of this project at the 15^th HA National Forum held from 11-14 March 2014 at IMPACT Forum, Muang Thong Thani. It also presented works at the International Forum on Quality and Safety in Healthcare 2014. Its presentation, in poster format, on “A Knee Arthroplasty Clinical Tracer Plus Project: Improving the Timing and Selection of Prophylactic Antibiotic Administration” was selected at the “Infection” seminar.

Research is also a major task of the unit. The Orthopaedic Surgery Unit has performed researches in cooperation with the Department of Orthopaedic Surgery, such as the researches on measurement of Knowledge of Pediatric Orthopaedic Patient in Education Program: The Diagnosis Plan, and the Evaluation of the Antibiotic Administration for Total Knee Arthroplasty under the Routine to Research (R2R) program. The Unit, in cooperation with the Department of Orthopaedic Surgery and Department of Anesthesiology has done a research titled “Can the Usage of Regional Block Room Save the Time in the Main OR?” to increase efficiency of operation room management. It worked with the Occupational Health Unit in studying on comparison of bacteria in operating room by collecting air sampling before and after operating room sterilization using hydrogen peroxide. The two projects were funded by the R2R (Routine to Research) Program. In addition, the Unit applies Lean concept in designing and improving work process to increase flexibility, stability and cost efficiency of the entire process and improving service efficiency and effectiveness. Example of such improvement programs are operating room equipment and supply management efficiency improvement and the tool and equipment management efficiency program. As a result, the Unit jointly with the multi-disciplinary team comprising perioperative nurse, Siriraj Sterile Supply Center and Department of Orthopaedic Surgery received the Gold Star Award 2013 – Lean-concept Innovation category. The award is a testimony of an organization development which becomes a good role model for internal and external organizations.

Thanks to its excellence, the Orthopaedic Surgery Unit has welcomed a large number of visitors to observe its work, especially in the orthopaedic operating rooms. Those visitors are from different organizations, such as participants of the Nursing Specialty Program and Program of Nursing Specialty in Perioperative Nursing of the Faculty of Nursing, Mahidol University, sports medicine students, Mahidol University, perioperative nurses from Rayong Hospital and Phra Chomklao Petchaburi Hospital, overseas medical teams from South Korea, Japan and the US. The Orthopaedic Surgery Unit has been participating in various activities of the Department of Orthopaedic Surgery, such as mobile surgery service at remote hospitals, preparation programs for patients and family prior to hip and knee replacement operations, Joints Health Club, Siriraj Orthopaedic Perioperative Nurse (SOON) Course in 2010 and 2012, the Nursing Symposium held in celebration of the 50^th anniversary of the Department of Orthopaedic Surgery.

In celebration of the 50^th anniversary of the Department of Orthopaedic Surgery, the Orthopaedic Surgery Unit wishes to confirm our commitment to working with moving forward together with the for the best benefits of the patients. We will help each other to achieve international excellence while continuing Prince of Songkhla’s intention to make this organization as the medical institute of the kingdom.

84^th Anniversary Patient Ward, 4^th floor West

The 84^th Anniversary Patient Ward, 4^th floor west is a special in-patient ward with 18 single rooms for orthopaedic patients aged nine years old up. The multi-disciplinary team comprises specialist, nurses and physiotherapists. The top five diseases found from 2011-2014 are spine surgery, fracture of the proximal part of femur, osteoarthritis of the knee, hip replacement and knee ligamentous injuries. The ward handled 400-500 patients per year on average. Spine surgery patients account for approximately 40-50 per cent of all patients. Occupancy rate per month is 60-70%. The ward has 24 staff members, including one head nurse, 10 nurses, 8 nurse assistants, one administrative officer and four general officers. In ward is managed to support vision and focus of the Faculty of Medicine Siriraj Hospital and the department. Its goal is to achieve safety, quality and productivity in patient care. In terms of safety, the department has a clear system in calling physicians. To ensure quality care, the ward ensures that critical patients always receive immediate attendance and care while adopting holistic patient care. The ward also monitors for postoperative complications such as infection, bleeding, neurological injury and pulmonary embolism. For spine surgery patients, the ward ensures that patients are free from neurological injury by implementing a postoperative neurological complication assessment project. From August 2013 – January 2014, the ward renovated its patient rooms for improved safety and patient care efficiency. As part of the renovation, restrooms are enlarged to increase convenience for patients using crutch, cane and walker and nurse call system and bathroom grab bars were installed near the toilet bowls, for example. Risks of falling have been regularly assessed by introducing the 4P Hourly Round system or checking patients regularly for “pain, pantry, potty and position”. This is because most of the patients are the elderly and all the rooms are single rooms.

In terms of quality, CPG Clinical Tracer and Clinical Tracer Plus systems have been introduced. The Department of Orthopaedic Surgery and the ward have worked together in improving such systems in order to ensure that patients receive high-quality treatment and fast services, feel good after the surgery and are satisfied with the services. To achieve this goal, the Department of Orthopaedic Surgery has provided skills and knowledge development support for the ward’s staff members, such as participation in the seminars and symposiums organized by the department and the Royal College of Orthopaedic Surgeons of Thailand, HA training by Healthcare Accreditation Institute (Public Organisation), and participation in the department’s patient monitoring project covering preoperative patient preparation, Hotline and consultancy service for postoperative patients and the get-together events for hip and knee replacement patients. The ward, through its medical illustration unit, has produced video to help patients prepare well before and after the lumbar spine surgery. The ward provides specific care to prevent bed sore which usually occurs after the surgery when patients still cannot move by themselves. Barden scale assessment is used when new patient is admitted, after the surgery and when the patient condition changes. The assessment is done every week until the patients are discharged. To prevent bed sore, the patients will be moved to change position every two hours while other equipment, such as air mattress, is used to reduce risk of bed sore. The “Easy Move” innovation was created in the Special Patient Ward 2 and introduced to the 84^th Anniversary Patient Ward to help its nurses move patients easily and safely. At the same time, its staff members do not have back pain afterwards. Our staff members encourage patients to strictly follow advice on postoperative care and rehabilitation, such as the deep breathing exercise, leg muscle exercises, including ankle pumping ROM exercise, long roll patient move, walk training using pickup walkers as part of physical rehabilitation plan and indicator of each disease. In 2014, 80 per cent of lumbar spinal injury patients can ambulate within five days after surgery. Our staff members have done research on effects of Thai traditional medicine massage on bowel elimination in postoperative lumbar lamienectomy patients. The R2R funded research is under the process of data analysis.  The ward won the Outstanding Unit Award in 2007, 2009, 2010 and 2012, Gold Star Unit Award in 2011, Outstanding Innovation/Project Award for our hair wash mobile unit in 2006, Fit for Fresh Project in2008 and Good-bye with Smile (well wishing card for discharged patients) in 2008.

In terms of productivity, the ward has adopted flexible people management system, allowing it to increase or decrease the number of staff members to match patients’ need and care and for safety. We also participate in the Share Jobs and Share Nurses Project with the 84^th Anniversary Patient Nurse, 4^th Floor East, which also handles orthopaedic patients in order to allow both wards to share staff members.  We also participated in seminars and activities, such as New Year’s Party, merit making and paying respect to senior staff members, to strengthen relationship of staff members at all levels and promote staff members morale and commitment to provide the best possible patient care.

Orthopaedic OPD (OPD 118)

Role and responsibility

The Orthopaedic Outpatient Department, known as OPD 118 is located at the Outpatient Building, 1st Floor, Room 118, and is under the Outpatient Unit, Department of Nursing Siriraj Hospital. We are also one of the Clinical Lead Teams under the Department of Orthopaedic Surgery. Our personnel include one chief nurse, seven nurses, 12 nurse assistants, four administrative officers, two medical statistic officer, three medical registration officer and two general officers.

Scope of service: OPD 118’s provides examination service for patients with acute and chronic bone, tendon, joints, muscles and partial nerve problems and abnormality that are inborn or caused by diseases or over one month accident. The service is provided on working days, from 7.00-15.00 hrs, to all patients both with appointment and walk-in patients. Patient screening and assessment are carefully performed in order ensure that patients receive the right diagnosis and treatment from specialists with specific expertise. Our services cover medication, medical procedure, rehabilitation and preparation for surgery, appointment making for non-admitted patients, consultancy for other departments or units, patient admission for those who need immediate treatment, and patient education on Mondays, Wednesdays and Fridays as well as general information provision.

Our major role and goal are to provide efficient examination and diagnosis, treatment, rehabilitation, prevention and health promotion for all patients with orthopaedic problems regardless of their age and gender by our physician, nurses, therapists and multi-disciplinary teams with special expertise in orthopaedics. Our main focus is to ensure good access to the right treatment through efficient screening process in order to identify individual patient’s specific needs and plan the right care and treatment as well as monitoring and evaluate the results. While doing all these, we place top priorities to accuracy, precision, speed, safety, convenience and no complication or other preventable disability. We ensure that patients receive sufficient information about the examination and their own conditions as well as the right behavior. We also promote health and knowledge on disease prevention among patients and families. In addition to patient care, we coordinate with other related units or health teams in order to ensure smooth transfer and patient’s satisfaction.

We have great team with expertise in orthopaedics, senior lecturers with high expertise in many subspecialties, such as Hand and Micro Surgery, Pediatric Orthopedics Surgery, OrthopedicsOncology, Trauma (+Adult Orthopedics), Sport Medicine, Spinal surgery, Adult orthopedics reconstructive surgery, Foot and angle and Metabolic bone disease. With our team’s knowledge and expertise, we can provide the right examination, diagnosis, treatment and perform the right medical procedure that meets international standard. Meanwhile, we play a key role in providing orthopaedic education to residents, fellows, medical students, nurses, medical team and other units within the hospital and external organizations in and outside Thailand. We also have a great team of highly experienced nurses with specific skills in orthopaedic care, a great team of therapists who can provide instruction on the right exercise to help patients prevent and treat health problems and adopt the right rehabilitation. This enables patients to have good health and better physical performance. We also have a Clinical Lead Team of the Department of Orthopaedic Surgery, comprising multi-disciplinary team and related units who are key driver of our high-quality service, academic and research works.

In term of service quality, we regularly hold ordinary meeting with related units to review and improve our service capability and continuous and efficient patient care process for emergency, chronic and general patients transferred from other hospitals or medical institutes. We have prepared the Clinical Practice Guideline (CPG) for different specific diseases. The guideline has been implemented and used as a framework for patient care, especially for osteoarthritis of the knee which is a part of the Area of Excellence of the Department of Orthopaedic Surgery. We have been fully participated in quality activities to provide efficient service to patient with osteoarthritis of the knee, for example, preparation of patients and family prior to the hip or knee surgery and activities by the Joint Health Club. We have participated in preparing Clinical Tracer Plus on total knee replacement, resulting in a special project on “no fat, no osteoarthritis of the knee”, a pilot project aiming at helping patients lose weight and enhance knee muscle capability. From this pilot project, we have developed it further to a research on a weight loss program for overweight patient with osteoarthritis of the knee. We plan to implement this program into routine service in the future.

The Department of Orthopaedic Surgery comprises many supporting units, including Administration Office, Academic Division, Education Division, Supplies Division, Research Division, Quality Development Division, Medical Registration Division and Information and Technology Division. These divisions provide quick and efficient support services to the Department and other units related to administration, document, personnel, finance, meeting arrangement, course management for both graduate and post graduate level, medical equipment and supplies, study and data collection for research, multi-disciplinary treatment, educational technology supplies, confirmation of patient information from medical data, and other services including social responsible activities and art and culture.

Division of Physiotherapy

In 1947, the country’s first physical rehabilitation was introduced at Siriraj Hospital. Professor Fuang Satsa-nguan, the head of Orthopaedic Surgery Department, began to use tools and physiotherapy practice to treat patients. He invented simple tools or applied the existing equipment for such activities, such as heat from reading lamp, massage, walking rehabilitation using parallel bars, and walking-assistant equipment. Later, more tools and equipment were acquired, doctors and nurses were trained to be physiotherapist to support the growing scope of work.  In 1963, Professor Fuang Satsa-nguan and Princess Prem (Ngarmchit) Purachatra in cooperation with WHO and World Confederation of Physical Therapy (WCPT) jointly established a physiotherapy school at the Siriraj Hospital. The first batch of physiotherapy students were recruited in 1965 from medical students Chulalongkorn University and Faculty of Medical Science. The selected students joined the third year of the school and when finished, they obtained a bachelor’s degree in physiotherapy and can become professional physiotherapists. At present, the school was upgraded to the Faculty of Physical Therapy, Mahidol University, offering undergraduate, graduate and PhD courses as well as short physical therapy courses.

Service

• Provide physical therapy for orthopaedic inpatients and outpatients. Its team members comprises specialists in different specialty area as follows:
  • Adult reconstructive surgery
  • Spine
  • Spinal cord injury
  • Sports medicine
  • Hand
  • Paediatric

Academic service

• Guest speakers on preparation of patients and family for hip and knee replacement surgery at the Faculty of Medicine, Siriraj Hospital, four times a year
• Host a symposium on “Update n Physical Therapy for Orthopaedic Condition” to celebrate the 50^th anniversary of the Department of Orthopaedic Surgery from 12-13 June 2014 at the Adityadhornkitikhun Meeting Room, Sayamin Building, 7th Floor, Faculty of Medicine, Siriraj Hospital

Studies and research

• Clinical instructors to supervise the training of 34 year 3 and year 4 physical therapy students from public and private universities
• Research on “A Randomized Control Study of Siriraj Home Exercises Protocol for Primary Knee Osteoarthritis Patients versus Usual Orthopedic Outpatient Consultation in Primary Knee Osteoarthritis Patients” which is under data collection stage

Chaloemphrakiat 10 South Ward

Chaloemphrakiat 10 South Ward was earlier called Mahidol Bampen 1 Ward. It is the first building in Siriraj Hospital. Today, it has 25 beds for pre and postoperative orthopaedic male patients aged 15 years up. The main goal of patient care and rehabilitation is patient safety. We have to ensure that patients do not suffer complication or impact from major risks. The ward also receives patients transferred from other hospitals because of complications of the disease with high risks from surgery. These patients need special care from specialist with high experience and expertise as well as a multi-disciplinary team. This includes patients with bone tumor, Brachial Plexus Injury (BPI) and cervical spondylosis myelopathy (CSM). The ward also receives accident patients from nearby area and those transferred from other hospitals due to complications, such as multiple fractures, older persons with fractures and other diseases that need care from specialists and multi-disciplinary team.  Top five groups of patients (2014 statistics) are trauma, hand injury, spine, tumor and arthroplasty. The Chaloemphrakiat 10 South Ward is operated with multi-disciplinary teams comprising orthopaedic lecturers and physicians, nurses, therapists and social workers.

Chaloemphrakiat 10 South Ward has continuously improved its organization in cooperation with the Department of Orthopaedic Surgery in order that it can best support the department and the Faculty of Medicine’s vision and missions. Improvement has been introduced in every step in patient treatment and care from patient reception until discharge, preoperative preparation and postoperative care. More importantly, our care does not limit to the patients but also their family as we have to ensure that the patients and family are ready to go home.  May new projects have been initiated in this regards. For example, we have the preoperative preparation project for knee and hip replacement patients to ensure they are ready physically and mentally, which significantly reduces risk of complications. We increase safety level at the ward through proactive risk management. The Department of Orthopaedic Surgery and Chaloemphrakiat 10 South Ward are the pilot organizations to implement Medication Reconcilitation which was later proven successful and clearly optimized benefits for the patients. The department also introduced the Quality Resident Project to improve efficiency in critical emergency patient care. As a result, residents can quickly help patients,  which best satisfied patients and their family.

In upgrading the ward towards excellence, we have implemented the Clinical Practice Guideline of each disease prepared by the multi-disciplinary team to ensure the highest possible efficiency in patient care and treatment. We have introduced Area of Excellence for TKA. We have created various innovations for patient care efficiency improvement. Box Alarm, for example, is a pain management tool that speeds up pain management process, resulting in higher patients’ satisfaction and fast recovery. The Box from Crutches was invented for older patients with bone fracture. In terms of communication, we have constantly communicated within the team and between multi-disciplinary teams and hold internal meetings to brainstorm for ways to improve excellence. These innovations and improvement have brought to the entire ward the pride for being part of the Department of Orthopaedic Surgery and playing a significant role in treating patients until they recover well and return home and have a better quality of life.

A significant milestone for any medical profession is to be recruited by a reputable organization. The Department of Orthopaedic Surgery has a strong culture of care where everyone at every level and units work closely together to achieve the goals on academic excellence and services. We work hard and play hard together, thus we are a strong organization with close tie. Senior lecturers are role model for the younger staff members and students not only in terms of knowledge and academic excellence, but also their contribution to the society as good and ethical doctors.

Roles: Service and Academic

Service

Being a tertiary center, Siriraj Hospital has a large number of patients. Fellows are responsible for patients in outpatient and inpatient wards, providing medical advices to patients in and outside the department, assisting senior staff members in surgery and standing by out of working hours. Having the opportunity to handle many patients means greater experience and skills.

Academic

Fellows work as coaches for residents in terms of academic activities, patient care, learning process and being role model on preferred qualities and personality.

Fellows also conduct various subspeciality activities, including conference and workshop as well as doing research. They also handle and participate in recreational activities and activities held by the department, Faculty of Medicine Siriraj Hospital and the Royal College of Orthopaedic Surgeon of Thailand to strengthen good relationship among members of the department and other departments as well as other organizations. Some of the activities are, for example, sports activities, freshmen orientation, homecoming ceremony, 50^th anniversary celebration of the department and welcoming travelling fellows.