1. To make
orthopaedic and
physiotherapy
services to all
parts of the
country.
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1.1 Have an
Outreach
Program-
Coverage of
quality
services to all
parts of the
country
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1.1.1 Outreach programme
specialists and
physiotherapist to
designated District
Hospitals. Have an
effective referral
system. To treat
whenever possible and
to refer when appropriate.
1.1 .2 Visitation by
sub specialists to
provide sub specialist
care wherever needed.
1.1.3 Improved day care
facilities
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All designated hospitals should
be covered.
All patients seeking Orthopaedic
or physiotherapy treatment in Govt. Hospitals will be duly treated. No patient will be deprived of such services.
Indicator:
Measure % of hospitals covered.
DHC - DHNC
----------------- X 100
DHC
Target: 100%
Frequency: 1-2 times in a month
SSCP – SSCNP
----------------- X 100
SSCP
Target: 100 %
Frequency : PRN
All Ortho Depts. must have day
care services by 2008
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Designated hospitals are hospitals,
which can support such services. One such hospital usually covers a few Districts in a big State and a few such hospitals
will cover the whole State. Depending on distance, referral made to the nearest designated hospital.
DHC = Designated hospitals should
be covered
DHNC= Designated hospital not
covered for any avoidable reasons.
SSC= Sub specialist care provided
SSCNP= Sub specialist care not
provided despite request
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and improved
quality of
manpower by
training for general
and subspecialty
care.
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2.1 Improve standards
and increase
training of
Orthopaedic
specialists /
sub specialists &
physiotherapists.
2.2
Enhance Subspecialty Orthopaedic Fellowship Training in KKM
2.3 Training of medical
officers, nurses
and paramedics
2.4 Retaining
manpower
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2.1.1 Increase intake at
local Universities /
Physio School
2.1.2 Encourage more
Universities to set up
Orthopaedic /
Physiotherapy training
programmes.
2.1.3 Encourage more
Malaysians with
recognized training
from abroad to return
to serve
2.1.4 Inculcate
culture of continuing medical education
and self improvement
2.1.5 More allocations
to run training programmes
2.2.1 Increase
no. of
scholarships and full
pay leaves.
2.2.2 Better promotion
prospects for those
passing
subspecialties
and also for trainers.
2.2.3 Credentialing
and
privileging at higher
level for those
passing formal
subspecialty training.
2.3.1 Visitation
to District
Hospitals (Outreach
Program) and train
doctors / nurses /
paramedics there to
carry out basic
orthopaedic /
physiotherapy care.
2.3.2 To set up
post basic
Ortho training in
Penang, Kuching
and Trengganu
2.3.3 To set up
a
programme to train
MA / nurses /
physiotherapists in
Ortho sub specialist
supportive care.
2.4.1 Increase remuneration
and promotion
prospects.
2.4.2 Increase in the
number of
promotional posts for
specialists &
physiotherapists.
2.4.3 Career
development
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Indicator:
Measure % of increase / year
NT – NF
---------- X 100
NT
NT= Total No. picked
to train in all
Universities.
NF= No. fail
Target = > 80 %
CME Grading
Indicator:
Measure % of scholarships &
paid leaves
NT – NWS
-------------- X 100
NT
Target = > 80 %
On gazettement as sub specialist, to be promoted to next higher grade on fulfillment of all criterias.
Trainers to be given faster promotion and incentives
Credentialing and privileging
certification and recertification
Indicator:
Measure % of personnel trained
at district hospitals to carry out basic ortho & physio care.
NT
---- X 100
TN
Target > 80 %
Increase to 5 by 2010 from the present
2
Full running programme by 2008
Preferably by 2010, all state heads should hold a JUSA post.
State & larger hospitals
> 6 specialists.
Bigger district or smaller state
hospitals 3-4 specialists.
Smaller district hospitals 2
specialists.
Subspecialist training
(see above)
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With current workload, KKM norms
of 2.2 ortho specialists per 100,000 population are inadequate. It should be
around 8 /100000. This however may change when the 1st batch of subspecialists completes their training in 2008-2009.
KKM norms;
Deficit of 286 ortho surgeons
by 2008
Should be much more, > 500
at current rate.
NT= No. in training
NWS= No. without paid leave or
scholarship throughout 4 years of training
1st batch of subspecialist
coming out in 2008-2009
NT= No. trained
TN = Total No.
Attachment 6-12 months at subspecialist care centers.
Brain drain is a serious setback
for any planning to succeed.
Ensure enough specialists to
cover other district hospitals on visitation.
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3. To improve
communication,
improve doctor-
patient relationship
ethical concerns,
& enhance public
perception of
doctors
& physiotherapist
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3.1 To provide courses
and a good working
environment.
3.2 Efficient delivery of
care
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3.1.1 Provide courses to
improve communication
skills, body language,
ethical considerations,
professionalism
and improve doctor
patient relationship.
Involving relations in treatment
decisions.
3.2.1 Improve
counter
services, reduce
waiting time, prompt
delivery of care, and
etc.
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2 courses a year
No. of substantiated complaints
or litigations / year
Target : 0 %
KKM norms
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Good communication skills, good
doctor patient relationships and perceptions are paramount in healthcare delivery leading to reduced litigations and complaints.
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4. To maintain the
delivery of high
quality, cost
effective,
orthopaedic and
physiotherapy
services.
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4.1 Maintain QA
activities
4.2 Enhance research
and development
4.3 Optimizing
Resources
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4.1.1 Continuous audit of
care delivered
4.1.2 Steps taken to reduce
medical errors,
mortality and
morbidity.
4.2.1 Identify problematic
areas in Ortho &
Physiotherapy
needing studies
4.3.1. Networking of
manpower, patients &
equipments within
Ortho & Physio
Depts.
4.3.2 Intersectoral
Cooperation
4.3.3 Avoid duplication
of
Services – doing
away with redundant services
4.3.4 Prioritization
of care
- Trauma care takes precedence
4.3.5 Increase
use of ICT
-
teleconsultation
-
link with other depts. & agencies
-
use of ICT in management of quality
-
keep national/ state databases and registries
-
In surgery
4.3.6 Ensure usage of
appropriate health
technology
4.3.7 Adequate allocation
for implants & replace
redundant equipments.
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KKM Norms
Mortality/morbidity meetings
in every Dept. at least once a month.
No. of studies with results needing
change in policy or practice
No of implementation of change in practice & policy
No of hospitals in the State
with low BOR to take In chronic patients for rehabilitation
All trauma cases to be done before 48 hrs.
Every department to have access
to internet facilities by 2008 and all correspondence & referral preferably via e-mail.
Ortho KKM website by 2006/2007
All new technology have to be assessed by HTA Dept. before use
To increase allocation by 10 % per year
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With corrective recommendations.
Use of consignment equipments
or facilities provided by private companies to save cost of purchasing.
Computer assisted surgery –
Navigation Systems. Able to do precision surgery for better outcome & reduced costs in terms of reduced hospital stay.
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5.To expand existing
service and
subspecialty,
upgrade facilities
and create new
service and
subspecialty
services
in designated
Hospitals
depending on the
needs of the
country
Menwujudkan Program Otopidik Subspecialty
(program baru)
To draw up new programmes for all Ortho subspecialty service.
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5.1 To change and
cope with
demographic
shift of population
and changing
disease patterns,
e.g. increase in
geriatric
population,
degenerative
diseases
5.2 Opening of new
Ortho and
physiotherapy
services in existing
hospitals.
5.3 Upgrading of existing
Arthroplasty
Services & creation
of new service
5.4 Upgrading of Spine
Services
5.5 Upgrading of General Orthopaedics and Trauma
services
5.6 Upgrading
of Pediatric Ortho services
5.7 Upgrading of Sports injury services
5.8 Upgrading of Ortho Oncological services
5.9 Upgrading of hand & upper limb services
5.10 Foot
& Ankle
Services
5.11 Setting
up Bone
banking services
5.12 Upgrading
of
Ortho OTs’
5.13 Upgrading
of
physiotherapy /
rehab
services
5.14 Multidisciplinary
DM foot
disorders clinic
5.15 Artificial
limb /
prosthetic
Center &
Locomotor
Assessment
5.16 Metabolic
bone
diseases &
Athritis Clinic
5.17 Rehabilitation
wards / hospitals
& A&E ward
concept
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5.1.1 Identify changes and shift
to plan for creating of such services – setting up of registries
P1 – Slim River, Perak
P2 – Kuala Lipis
P3 – KIV - Pekan/Mersing area
Existing service,
HKL,
HAS, HPP,
H
Melaka, H Kuantan
New service,
H
Pandan / HSAJB
KIV- HU Sarawak (HUS)
HKB
Existing services,
-
HKL, HAS, HPP, H Ipoh,
HKT, HUS, HTAR, H Sg Buloh
New services,
H Pandan
KIV
HKB, HQE
Continuing support of all Ortho
Depts.
Setting up of trauma centres
Existing Services,
HKL,
HKB, H Selayang
New service
KIV HPP, H Pandan, HAS
HTAA
Kuantan, HUS
Existing service,
HKL,
New service
H
Serdang, H Pandan, KIV HPP, HUS, QEH, HKB
Existing service
HKB, HPP, HKL/ Putrajaya HUSarawak (Unimas)
New service
H Pandan,
QEH
Existing
service –
H Selayang
New service
KIV -HKL,
HTAA, HTAR
1 in Northern region, 1 in Southern region & 1 in
East Malaysia. *
- Hospitals to be identified later
Existing, HKL
New service at HPP
Laminar flows and endosuites
Increase personnel and upgrading of instruments in all
physio / rehab facilities.
Setting up of a multidisciplinary DM foot clinic
Future planning depending on needs and financial situation
Future planning depending on needs and financial situation
Reduce use of acute beds, save costs & manpower
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No. of registries to be set up
on common ailments.
Target: 2 by 2008
1 Ortho specialist to
20,000 population
Surrounding radius distance of > 100 km
At least 1 trained personnel
/ sub specialist in these centers.
1:100,000 population
At least 1 trained personnel
/ sub specialist in these centers.
1:100,000 population
Increase budget allocation of
10 % per year for trauma services
At least 1 trained personnel
/ sub specialist in these centers.
1:200,000 population
At least 1 trained personnel
/ sub specialist in these centers.
1:200,000 population
At least 1 trained personnel
/ sub specialist in these centers.
1:200,000 population
At least 1 trained personnel
/ sub specialist in these centers.
Nomination for scholarship 2006
Setting up at HPP by 2006/2007
In regional Hospitals by 2010
By 2010, to be able to offer
daily physio service as compared to 1-2 times weekly as offered presently
In all Ortho Depts. by 2010
Planning to start in RM9 for
RM10
Planning to start in RM9 for
RM10
Planning to start in RM9 for
RM10
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P1 = phase 1
(2006-2007)
P2= phase 2
(2008-2009)
P3 = phase 3
(2009-2010)
To cope for the ageing population
and increase in the number of patients
requiring such subspecialities.
Building ready by 2005
Prevent infections
According to CPG
Affordable prosthetic and orthotics
for poor patients
Gait analysis
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To prevent and
reduce disease burden
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1
To implement
preventive
measures to
reduce burden of
orthopaedic related
screening
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1.1 Have public awareness and education programmes
on Ortho related diseases
1.2 Program to reduce incidence of falls in
elderly patients
1.3 Program to prevent osteoporosis and improve
bone density
1.4 Program to reduce obesity
1.5 Back care program
1.6 To develop and improve community physiotherapy
and strengthen wellness and back to work programme.
1.7 Education to reduce motor vehicle accidents
and work related accidents
1.8 DM foot prevention
According to CPG
1.9 Aggressive approach to
combat nosocomial
infections in wards.
2.1 All compound fractures
must be operated upon
urgently
2.1 Some ortho
condition
needs to be treated
sufficiently early to
reduce morbidity
2.2 Use of Computer
assisted surgery /
robotics
2.3 To ambulate
elderly
patients after
operation or from bed
rest as early as
possible
3.1.1 Scoliosis screening in
schools
3.1.2 DM foot screening &
prevention
3.1.3 Screening of elderly
patients on discharge,
to see whether they
have family support &
whether they can
come for follow up
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Two programs a year
To
commence as soon as possible
To commence as soon as possible
Ongoing at physio Depts., ensure
continuity
Ongoing at physio Depts., ensure
continuity
All hospitals with Ortho &
Physio Depts. must carry out this programme by 2008
All hospitals with Ortho & Physio Depts. must
educate patients on their follow up as well as to the public via forums and exhibitions.
All depts. to have a program
by 2010
All Depts. To have a committee
to oversee nosocomial infection prevention.
Before 8 hours
All hospitals must have a daily
Trauma OT 0f 8 hours by 2008
To have increase Ortho OT time
in all hospitals by another 60 % by 2010
To obtain Navigation systems by 2006 in selected centers.
HKL, HPP, HAS
All physio depts. to have a plan to ambulate by 3rd POD unless contraindicated
Ongoing program, may be shelved
if not cost effective
All hospitals must have a multidisciplinary
DM foot screening program by 2010
All depts. to have such facilities by 2010
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Collaborate with Bhg. Sumber
to have forums and exhibitions
R&D to determine factors
causing falls in the elderly and measures to prevent it
Exercise and body balancing programmes
Reduce stress on joints &
reduce backache
Reduce backache and early back
to work
Community physio – training
of nurses at heath centers to carry out simple basic physiotherapy.
Collaborate with Road Safety
Council and SOCSO
Multidisciplinary
approach
To
commence immediatedly
Delayed treatment results in
complications needing prolonged
treatment & costs.
Statistics shows marked increase
of Ortho operated cases as compared to nearest discipline by approx. 80 %
Reduced hospital stay and save
costs
Precision Surgery
Faster recovery
To start immediately
Prevent morbidity
According to CPG
To “catch” neglected
elderly patients not able to fend for themselves.
Collaborate with Social Welfare
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