ArticleBMJ open quality2026
Improving GIRFT compliance and patient experience of accessibility and shared decision making for elective hip and knee replacement: incorporation of a digital patient information leaflet.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate whether QR (Quick Response) code-linked digital patient information leaflets (PILs) improve documentation of shared decision making (SDM) and patient experience in elective hip and knee replacement clinics.
designA two-cycle quality improvement project (completed audit loop) comparing preintervention and postintervention outcomes.
settingElective orthopaedic clinics in a UK district general hospital (secondary care).
participantsPatients listed for elective hip or knee replacement during two 6-week periods (25 in cycle 1; 43 in cycle 2). Patients with incomplete records or not assessed face-to-face were excluded.
interventionsIntroduction of QR code-linked digital PILs between audit cycles, provided at clinic appointments. The resource included procedure information, anaesthetic options, recovery expectations and links to translation services. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were documentation rates of PIL provision and key SDM domains in line with NICE NG157 (National Institute for Health and Care Excellence Guidance) and GIRFT (Getting it Right First Time) standards. Secondary outcomes were patient-reported measures of clarity, usability, accessibility and preference, obtained through an anonymous Likert-scale survey.
resultsDocumentation that a PIL had been offered increased from 7% (hip) and 9% (knee) in cycle 1 to 24% and 36% in cycle 2. Documentation of patient understanding rose from 79% to 90%, and recovery expectations from ≤9% to 36%. Survey results showed 100% of respondents found the digital information clear, 86% preferred it over paper and 71% reported greater engagement with the digital format.
conclusionsQR code-linked digital PILs improved documentation, engagement and accessibility in elective orthopaedic clinics. This low-cost, scalable intervention supports national guidance on SDM, aligns with NHS (National Health Service) Green Plan sustainability goals and has potential for spread to other surgical pathways.
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