Notices for surgeons

Please see below all notices for surgeons.

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NJR Data Quality Audits

NJR Data Quality audits

Click here to find information about the NJR Data Quality audits.

Clinician Feedback

Clinician Feedback

You can access your clinician feedback by logging into our NJR Connect – Data Services portal

2024 updates to
NJR Connect – Data Service
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Updates to NJR Connect – Data Services


Changes to NJR Connect 2024
Click here for all updated information.

Surgeon push notifications
NJR Connect – Data Services enables monthly ‘push notifications’ to consultants, alerting them through email to the presence of newly linked events for their patients within the NJR data and facilitate their checking and validation of this data.

This capability notifies surgeons of each of their attributable linked revisions and 90-day mortality events, providing a secure link for them to click through to log-in to NJR Connect – Data Services system to review the update and requires surgeons to acknowledge each attributable revision and 90-day mortality event. The mechanism also notifies surgeons via email of the existence of new Consultant Level Reports and sends reminder prompt emails to those who have not recorded their declaration against their annual Consultant Level Report.
 
The benefits of this notification are that: 
data will be presented back to surgeons on a case-by-case basis enabling more frequent alerts for timely validation.

the validation by clinicians of key data items such as linked revisions and 90-day mortality is strengthened, providing a more timely mechanism for surgeons to review each linked event and resolve any ‘incorrectly attributable’ events

the process is automated to remind surgeons of the need to record consultant declaration at the time of the recorded appraisal date.

there is also an automated reminder to support surgeons in completion of their consultant declaration.

Clinician Feedback
The requirement for a Consultant in Charge to declare the download of their Consultant Level Report and provide the date of their next appraisal has been removed. As a result of this the following changes will be seen:

Static report grid – the final 2 columns (Declaration and Appraisal Date) have been removed.

Outcome Summary Report – the final item in the header row (CLR Declaration) has been removed.

Attributable revision report – as this report shows both revision of primary procedures and revision of revision procedures the field heading in the record level drop down has been updated from “Primary” to “Index procedure” to avoid confusion.

Management Feedback
The requirement for a Consultant in Charge to declare the download of their Consultant Level Report and provide the date of their next appraisal has been removed. As a result of this the following changes will be seen:

Static report grid – the final 2 columns (Declaration and Appraisal Date) have been removed.

Consultant Declaration status report has been re-named to CLR download. The “Declaration confirmed?” field has been removed from the report.

CLR download report – informational text has been added to the report – please click on the green i button to display the text.
Attributable revision report – as this report shows both revision of primary procedures and revision of revision procedures the field heading in the record level drop down has been updated from Primary to Index procedure to avoid confusion.

Supplier Feedback
The “Prostheses used in joint replacements” report is now available to users with access to the Supplier Feedback Activity reports.

NJR Connect – Data Services
All orthopaedic surgeons can now log in and review their Clinician Feedback, outcome data and reports on the NJR Connect – Data Services platform. The new system includes the following functionality:

CLRs and SLRs (this year’s reports have been available to download since September 2023).

Dynamic reports – View and interact with their own data using predefined filters.

Static reports – View and download a range of pdf and excel document reports. For example: Consultant Level Reports and Annual Clinical Reports.

90-day mortality / attributable revisions module – View a list of records, dating back to 1st January 2019, with ability to drill down to see further details.

Resources – Access a list of useful supporting documents including system user guides and user training videos, as well as links to other NJR websites.
NJR Contacts database – Search for other surgeons who practice at the same hospital.

ACR Reports for FY 2022/23 will be available in November 2023.

NJR Connect – Data Services can be accessed via the ‘Quick Links’ section of this page.
Surgeons will be redirected to the new system should they attempt to login to Clinician Feedback, as this new system replaces that service. They should use their previous Clinician Feedback user ID to log in and will then need to click on the ‘Forgotten password’ link on the login page, to enable a temporary password to be created and emailed to them, in order to access the system for the first time. The temporary password can be changed at any point thereafter to a password of choice.

There is also a user guide to support log-in as well as a useful video explaining the log-in process. You can find these in ‘Quick Links’ and ‘Related Documents’ on the left-hand side of this page. Any problems with logging in can be reported to the NJR Service Desk (details at foot of page) who will support surgeons to gain access to the system.

NJR Surgeon and Hospital Outcomes Publication 2022/23

NJR Surgeon and Hospital Outcomes Publication 2022/23

The outcome results for FY2022/23 will be published on the NJR Surgeon and hospital website in January 2024.

The timeline for surgeons to review their data is 1 December 2023 to 2 January 2024. All consultant orthopaedic surgeons in England, Wales, Northern Ireland, the Isle of Man and Guernsey, who have carried out at least one hip/knee/ankle/elbow/shoulder joint replacement procedure as ‘Consultant in Charge’ in any hospital in the above regions during the most recent financial year from 1 April 2022 to 31 March 2023, will be included for publication.  

Please click here for further details.

Management Feedback
Annual Clinical Report (ACR)


NJR Management Feedback can be found through our NJR Connect – Data Services new suite of reporting services.


Click the link below to access NJR Connect:
NJR Connect – Data Services

The reporting system presents hospital management staff with range of reports to give a thorough overview of key indicators of their hospital’s performance in joint replacement. This has always been presented in an Annual Clinical Report (ACR) using NJR data for the most recent financial year covering:

– Indicators of data quality: rates of compliance, patient consent and linkability.
– Hip and knee replacement outcomes data (funnel plots), for revision for all units and surgeons (anonymised), across procedure types.
– Unit outcomes data for hip and knee replacement (funnel plots) for mortality.
The report for FY2022/23 will be available for every hospital from 30 November 2023.

Changes in this years report are:

– Now that surgery is back to pre-pandemic levels, the definition of an active surgeon has reverted back to one year from two years. i.e. surgeons will only be shown as active if they have activity recorded in the latest 12 month reporting period

– The Shoulder PROMs report has been reinstated, comparing completion rates for the previous two calendar years.

– Changes to indicator summary thermometer plots to make the layout and reading consistent. We have made the data quality funnel plots show better than results to the left and worse than results to the right of the thermometer plot.

– Data quality audit section now includes results for ankle, elbow and shoulder.

NJR reporting for specialty and associate specialist (SAS) doctors and trainees

NJR position on specialty and associate specialist (SAS) doctors and trainees who have a joint replacement practice

The question has been raised a number of times as to whether an SAS doctor or trainee could have their own registry report of the record of joint replacements they have performed. There appears, therefore, to be significant uncertainty about this in some quarters and so we would like to confirm that the ability to obtain data about their cases has been available to SAS doctors and trainees for many years. This facility differs in some respects between SAS doctors and trainees.
 
The NJR recognises that some SAS doctors, in particular ‘associate specialists’, have their own practice in joint replacement (and other areas) and that those surgeons conduct that practice with varying degrees of independence.  Nevertheless, all patients admitted within the health service for such treatment are under the care of a named consultant. For this reason, since its inception, the NJR has always collected data about not only the lead surgeon but also the consultant-in-charge of the case.
 
The NJR believes that all surgeons should be able to benefit from the monitoring of their own practice, just as consultant surgeons are able to do. Therefore, all SAS and trainee surgeons performing joint replacement as a lead surgeon are able to access their NJR data online through the NJR Connect – Data Services platform and can obtain the appropriate username from the NJR Service desk. All surgeons have access to dynamic activity reports (updated daily/monthly, as appropriate to the report) and outlier analysis funnel plots (updated bi-annually). Data used to analyse outcomes for SAS and trainee surgeons include all procedures where they are the named lead surgeon.
 
In addition to the dynamic reports, SAS surgeons with sufficient eligible procedures in the latest financial year will also receive an annual Surgeon Level Report (SLR). Whilst trainee surgeons do not receive an SLR they can see all the relevant data and funnel plots where they are registered as the lead surgeon, and are able to take screenshots of the data for use in annual reviews.
 
In some circumstances we are aware that a case may be attributed to the incorrect consultant-in-charge but this should not affect the assessment of the lead surgeon (and therefore SAS surgeon) data. Where such incorrect attribution has occurred it is possible for the ‘consultant-in-charge’ (or indeed the ‘lead surgeon’) data to be corrected. It is preferable for this to happen as soon as the error has been identified and on a case-by-case basis. This applies whether the case incorrectly attributed is a primary case or a revision case. Changing the attribution in this way can be actioned by the relevant NJR compliance officer with the agreement of BOTH consultants. Where surgeons are requesting more than one or two such cases are ‘re-attributed’, referral to the NJR management team will generally be required, in order to ensure that no ‘gaming’ of the system is occurring.
 
Occasionally it has been noticed that surgeons reaching ‘outlier’ status (at alarm level for revision rate) may have then identified some of their revised cases where the primary operation has actually been performed by another surgeon (consultant OR SAS doctor). In this situation it would still be possible to correct the mistake, but it is more complicated and should require the agreement of the NJR management team as the surgeon’s whole practice would potentially need to be audited and ‘corrected’.  
 
The reason for this is that simply transferring some revised primary cases from one surgeon to another can cause distortion of the analysis of the ‘Standardised Revision Rate’ for both the surgeon transferring the case AND the surgeon accepting the case.  There could have been significant numbers of cases erroneously placed under the wrong surgeon/consultant in these circumstances and it is essential that the relevant data point (ie consultant-in-charge and lead surgeon) is corrected for both the revised cases and the primary cases, so that the denominator as well as the numerator is correct for analysis.  This sort of problem seems particularly likely to affect associate specialists and other more senior SAS doctors as they have many more cases which may be attributed to different consultants-in-charge.
 
Some surgeons have expressed the view that only lead surgeon data are relevant and only those data should be used for analysis. It is the view of the NJR, the BOA and the specialist societies (expressed through the NJR Medical Advisory Committee) that a consultant surgeon who has patients who are operated on by other surgeons, such as trainees and SAS doctors, should be able to audit those cases and monitor the outcomes just as they can for cases performed by themselves. It therefore remains the case that NJR analysis will be performed both on consultant-in-charge and on lead surgeon data.
 
It is essential that all SAS doctors and trainees performing joint replacement ensure that every primary and revision case that they do is correctly attributed, both in consultant-in-charge and lead surgeon data, on the NJR MDS form submitted at the end of each case. In that way they will be able to receive accurate and reliable reports on their practice.
 
We occasionally receive requests to designate an SAS doctor as a ‘consultant-in-charge for the purpose of NJR analysis.  We do not believe this is appropriate.  Full analysis of the SAS doctor’s own cases should be possible using the SLR with the lead surgeon data.  If the surgeon is actually acting as a consultant then we should wish to know why they have not been appointed as a consultant.  If they are still operating ‘under licence’ on other consultants’ cases, then it is in the interests of the SAS doctor, the consultants and the patients, that the doctors concerned are all able to see and monitor the outcomes of their cases. We believe that is best achieved by continuing to register cases under both the consultant-in-charge and the lead surgeon and to analyse these separately.
 

Surgeon access to
NJR Implant Library

Surgeon access to NJR Implant Library

All surgeons registered with the NJR can have access to the NJR Implant Library through their NJR Connect – Data Services account.

The NJR Implant Library includes the following two dynamic reports in table format relating to implant performance:

The Implant summary report contains data relating to implants used in primary procedures. Kaplan Meier (KM) estimates of the cumulative probability of revision at 1, 3, 5, 10, 13 and 15-year intervals enable the assessment of implant performance over time.

The Implant and construct outliers report lists implants and implant combinations that have been reported to the MHRA as Level 1 outliers. An implant, or implant combination is considered to be a Level 1 outlier when the performance exceeds the acceptable control limits compared to the implant group.

Reports are available to Clinician Feedback users on the NJR Connect – Data Services portal – using the Implant Library tile or the Implant Library menu options.

Consultant Level Report (CLR) and Surgeon Level Report (SLR) FY2022/2023

Changes to Consultant Level Reports (CLR) and Surgeon Level Reports (SLR) for the Financial Year 2022/23.

This year’s CLRs and SLRs were published on 19 September 2023, to coincide with our presence at the BOA’s Annual Congress in Liverpool.

Whilst the number of changes in the CLR/SLR reports are limited, the most significant to note can be seen on a PDF by clicking here. CLRs can be accessed via NJR Connect – Data Services

Recording Consultant Level Report (CLR) download status in NJR Annual Clinical Reports
Whether or not a surgeon has already downloaded their CLRs will be recorded in the ACRs of hospitals where they have been active as a Consultant in Charge in the last two financial years.

Surgeons are advised to review and check their CLR reports and get in touch with the NJR Service Desk if there seems to be any data missing or if it has been wrongly attributed.  If you have not yet accessed NJR Connect, a link to the login user guide can be found on the landing page login screen (please click on ‘Further Information: User Guide’).

Trust and independent hospital NJR Annual Clinical Reports (ACR) for FY2022/23 are also available to download from NJR Connect from 30 November 2023.

NJR Minimum Data Set (MDSv8)

NJR Minimum Data Set (MDSv8)

MDSv8 data collection forms are available to download on the website here

Last year we commenced an exercise to review the developments we need to implement to enable us to update the MDS and we are pleased to advise that the data entry system has been updated for input of the new procedures contained in MDSv8 forms.

Since the National Joint Registry (NJR) was launched in 2003, we have periodically reviewed and updated the Minimum Data Set (MDS) to ensure that we are capturing data relevant to contemporary joint replacement practice and can achieve our objectives to monitor the quality and safety of orthopaedic services. The last review of our data collection took place in 2017/2018 and there have been many progressive advancements in surgical procedures since then.

We have consulted with relevant orthopaedic specialist societies on these data collection changes and feel that they represent a major step forward in enabling the NJR to fully monitor the outcomes of all joint replacement procedures. The changes are in line with the increased vigilance of implanted devices engendered by the Cumberlege report and the newly developed Medical Device Registries and Outcomes Programme.

More information on the changes in MDSv8 and hospital checklist here:
Update of NJR Minimum Data Set forms

Component information

Component Information

If a surgeon is planning to undertake a revision of either a primary or a revision joint and wishes to know what components were implanted in the previous procedure, they should contact the NJR Service Desk using the contact details below.  This assumes that the revising surgeon is different to the surgeon who undertook the previous procedure and cannot, therefore, access the information via NJR Connect – Data Services.

When contacting the NJR Service Desk, a surgeon should state that they require information about the implants that were used in a patient’s previous joint replacement procedure and provide an NHSMail email address through which they can be contacted.  They should NOT provide patient details at this stage.

Using the NHSMail address provided, one of the NJR data service team staff will contact you for details of the patient and once these have been provided and the patient has been positively identified, details of the components implanted during the previous surgery will be identified.

NJR Service Desk: enquiries@njrcentre.org.uk  Tel:845 345 9991 (Monday to Friday).

Consultant Level Report (CLR) and Surgeon Level Report (SLR) FY2021/2022

Consultant Level Report and Surgeon Level Report 2022

Consultant Level Reports (CLR) and Surgeon Level Reports (SLR) have been available to download since 13 July 2022 at NJR Connect – Data Services. The changes to this year’s report can be found by clicking here.

Since 2019 we have provided a Surgeon Level Report (SLR) for all surgeons who are ‘associate specialists’.

To qualify for the report, a surgeon should have performed at least five combined hip and knee procedures or one ankle, elbow or shoulder procedure, during the previous two years. It is possible that some surgeons will receive this report in addition to a Consultant Level Report (CLR) and this could be for one of the following two reasons:

If during the past year you have a new consultant level position, you will have procedures linked to you as both a consultant and an associate specialist.

If there has been a data entry error and procedures have been attributed to you at the wrong grade (in this case, you will need to contact the Data Entry staff at your hospital to update the relevant records).

Surgeons are advised to check their reports and get in touch with the NJR Service Desk if there seems to be any data missing or if it has been wrongly attributed.

Understanding ODEP / NJR data
ODEP and the NJR work closely together in order to collect and monitor joint replacement data in the UK and the data in the NJR Consultant Level Reports (CLRs) are courtesy of both organisations. There are some important points that you shouldn’t overlook, particularly as the data you now are receiving are more comprehensive.

Please see this explanatory document which will make the data easier to understand.

Related documents

Quick links

Surgeon and Hospital Profile website

NJR Connect – Data Services

NJR Data Entry System

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