Table 5.

Problems identified and contributory factors in orthopaedics

Stage in process of care	Principal problems identified	Contributory factors
Diagnosis	Incorrect or delayed diagnosis	Lack of consultant involvement
Preoperative assessment and care	Inadequate preop assessment/care	Ward doctors inadequately monitored
Anaesthesia, operative and invasive procedures	Technical	?Competence of operator
	Infective	?Prophylactic measures
Ward management	Pressure sores	Failure to identify at-risk patients and to undertake prophylactic measures
	Chest infection
	Multiple disease processes in the elderly	Problems with care of the elderly
Use of drugs and intravenous fluids	Very few problems except for maintenance of regimens for medical conditions	Inadequate involvement of physicians with a special interest in care of the elderly
Discharge procedures	Patient's medical condition not adequately understood	Failure to involve geriatricians in care
	Inadequate assessment of mobility	Failure to provide adequate ‘package for home care’
	Poor communication with GP/community services	No protocol for discharge