Increased precision and cost savings with orthopaedic PACS and surgical planning tools

The Kliniken Ludwigsburg-Bietigheim GmbH has 1,690 beds and cares for almost 57,000 inpatients and 60,000 outpatients per year. The hospital group comprises the Ludwigsburg hospital center and the hospitals in Bietigheim, Marbach and Vaihingen, as well as the Clinic for Geriatric Rehabilitation in Ludwigsburg. Combined, the group employs almost 4,000 people.

Germany’s Ludwigsburg hospital center digitizes orthopaedics

With 1,100 beds, the Ludwigsburg hospital center is the largest in the group. Composed of 12 clinics, five departments and four
institutes, this center for full-level care covers about 500,000 people in the Ludwigsburg administrative district.
The Clinic for Accident, Hand and Restorative Surgery at the Ludwigsburg hospital center carries out approximately 2,700 operations each year. Much of the Clinic's treatment involves endoprosthetics and the provision of medical care to patients with
post-traumatic conditions. Due to its links with the hospital's renowned Neurosurgery Clinic, patients with multiple orlife-threatening injuries from outside the hospital's catchment area are frequently admitted to the Clinic. In total almost 20,000 emergency patients, and approximately 8,000 returning outpatients are treated at the Clinic for Accident, Hand and Restorative Surgery annually.

Going digital

The Ludwigsburg hospital center is in the process of digitizing its entire facility. Total investment for the project, which the hospital has entitled "Radiology 2000", is 7.6 million euros. One of the key elements in the digitization project was the implementation of a Radiology PACS (Picture Archiving and Communication System), which was introduced in 2001.The hospital viewed the Radiology PACS not just as a project for Radiology, but as a hospital-wide project that would replace all X-ray films.The hospital also decided, as part of "Radiology 2000", to proceed to further digitization and implement an Electronic Patient Record (EPR). In general use since 2003, the EPR at the Ludwigsburg hospitalcenter includes all patient management,outpatient and inpatient accounts (including accounting for chief consultants, book-keeping and stock management), and medical areas,including medical correspondence and the management of hospital-wide communication.Since the introduction of IMPAX for Orthopaedics, part of the hospital's comprehensive solution from Agfa, the way that surgeons at the institution work has changed entirely. "Detailed surgical planning is essential for success and must be documented. Digital working methods can help achieve this," says Dr. Kai Scriba,a Senior Physician at the Clinic for Accident, Hand and Restorative Surgery.

"Conventional surgical planning methods areless accurate because there is no real 1:1 relation between film and patient. The reason for this is the changing film focus distance between all the different body sizes. With digital planning solutions, especially with Agfa's OT3000 Orthopaedic Workstation solution, the images are calibrated in a much more accurate way," explains Dr. Scriba. Since 2003, all 15 staff members at the Clinic for Accident, Hand and Restorative Surgery have been working with the new solution.Today, most of the Clinic's surgery is planned in advance using the digital technology. The orthopaedic planning software provides all required prosthetics templates and ensures an automatic 1:1 representation of the images on the monitor. After pre-operative planning, the images are distributed digitally to the surgery rooms and beyond. The IMPAX solution is currently available in all operating rooms where all images from the PACS archive can be viewed over the IMPAX web server. Dr. Scriba is an enthusiastic advocate of the digital solution for orthopaedics. "When we were selecting the system, ease-of-use and an intuitive user interface were the decisive criteria. The IMPAX solution from Agfa met these requirements most precisely, more so than all other competitive systems."

Rapid implementation

"We installed the system within ten days and 'armed' it overnight," explains Dr. Scriba. This approach required meticulous preparation. "The implementation was undertaken without any problems due to the remarkable support provided by Agfa," he says. Since the benefits were clearly conveyed and quickly became evident,including the stability of the system, acceptance levels were very high from the start.

More precise, and saves both costs and time

"After one-and-a-half years, IMPAX for Orthopaedics has delivered significant benefits. We are simply providing a higher level of quality. Planning is more accurate and rapid, and sources of error are eliminated," summarizes Dr. Scriba. Various prosthetic parts can be tested and corrections made easily. Consultations with colleagues are also much simpler. A further key factor is the time saved. "While we used to need 25 minutes for conventional prosthetic planning, Agfa's system now lets us do the same task in 10 minutes," says Dr. Scriba. The financial advantages are evident too. "We are saving at least one image per patient in the planning stage. The increased accuracy has also resulted in fewer post-operative images being required," he says.The crucial cost factor, however, is the surgical time saved, especially when taking into account the operational costs in an operating theater. "Potential savings are becoming increasingly interesting as we are now heading towards a situation where sooner or later we will have to 'rent' operating rooms and be billed by the minute," says Dr. Scriba. "I can also envisage potential savings with regard to preparing operating rooms correctly by reducing the technical effort, and in reducing the number of implants opened unnecessarily. I can also envisage particular savings in this area in terms of orthopaedic spines. In my experience, we can reduce the 'cut-stitch' times (currently used to measure everything in German operations) by logical and accurate planning."
More accurate planning allows certain operations to be carried out in half the time, and the number of complications has fallen dramatically. Taken together, these benefits deliver higher levels of both patient and employee satisfaction.