AAOS Bulletin - June, 2006

Boards approve position statement on children’s musculoskeletal health, hear progress reports

By Susan A. Nowicki, APR

The Boards of Directors of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) met on March 21, 2006, in Chicago. They approved a position statement on children’s musculoskeletal health, adopted a revised policy on Web site advertising and sponsorship and heard updates on trauma/on-call issues, the AAOS Patient-Centered Care Initiative and the Orthopaedic PAC. The Boards also recognized several members retiring from volunteer positions.

Trauma care/on-call issues

Presenting what he called “food for thought” on the current crisis in trauma care, James H. Beaty, MD, 2005–2006 second vice president, outlined an action plan for implementing the recommendations of the Academy’s Project Team on Trauma Care/On-Call Issues, which he chaired.

Today’s practice environment has given rise to a growing realization among orthopaedists that they are being urged to provide emergency care with poor compensation, high liability and often less-than-adequate hospital and staff support. Dr. Beaty said that taking call and providing emergency care services have become points of contention. The Project Team on Trauma Care/On-Call Issues, created in May 2005, has developed 10 recommendations. Dr. Beaty presented, and the Board approved the plan, which includes six primary steps:

First Vice President, James H. Beaty, MD, outlines an action plan on trauma care/on-call issues.

1. AAOS should develop one or more position statements on emergency care services that make it clear that the orthopaedic community, as a whole, has a responsibility to ensure that physicians are appropriately compensated for providing emergency care, that emergency patients with musculoskeletal conditions receive trauma care services and that conditions in which orthopaedic surgeons and other physicians provide these services be improved.

2. AAOS should compile information to help orthopaedists work with hospitals regarding on-call issues.

3. Orthopaedic Trauma Association and the Board of Councilors (BOC) should work together to develop guidelines on when to transfer orthopaedic emergency patients to other facilities.

4. The BOC State Legislative and Regulatory Issues Committee should draft model legislation and other resources to help state orthopaedic societies pursue laws that will raise the burden of proof above the norm and set caps on noneconomic damages in medical liability suits brought by emergency room patients. The Washington office should work with the Emergency Medical Treatment and Active Labor Act (EMTALA) Technical Advisory Group on ways to improve EMTALA and related regulations.

5. AAOS leadership should monitor and continue to discourage development of a proposed new acute surgical care specialty.

6. AAOS should monitor the impact, if any, of the new resident work hours on emergency orthopaedic patient care and respond as appropriate.

Position statement approved

The Board approved a position statement developed by the Public Education and Media Relations Committee on children and musculoskeletal health that references statistics about the prevalence of musculoskeletal conditions in children, makes recommendations for improving musculoskeletal health and calls for additional research.

Presented by Stuart A. Hirsch, MD, then chair of the Council on Communications, the position statement reads in part,

“As the musculoskeletal system matures and grows during childhood, the AAOS stresses the importance of physical activity for children to maximize strong bone and muscle potential and combat obesity. The AAOS also believes additional research should be conducted to improve patient care and enhance the treatment and prevention of childhood musculoskeletal conditions, drawing from evidence-based medicine.”

Revised Web site advertising policy adopted

The Board first adopted a policy on advertising and sponsorship of the AAOS Web site in June 2000. Originally, it was envisioned that the Web site might break even or provide revenue. However, very few companies have sought to advertise on or sponsor the site.

Recently, one company did contract with the AAOS to advertise on the site’s home page. Some concern was expressed about the placement of the message in such a prominent position. As a consequence, AAOS legal counsel suggested revising the policy to permit advertising on internal, or “landing pages,” but not on the home page. After discussion, the Board approved the revised “Internet Web Site Advertising and Sponsorship Policy,” which allows placement of advertising on selected landing pages linked to the AAOS home page, but not directly on the home page.

AAOS President Richard F. Kyle, MD, responds to a question.

Medical errors survey report

David A. Wong, MD, chair of the Patient Safety Committee, reported on the results of a medical errors survey conducted with the AAOS membership on frequency, cause and outcomes of medical errors. Of the 917 members who responded to the survey, 510 reported an incident in the past 12 months.

Of these incidents, 78 percent occurred in the hospital (52 percent in surgery, 10 percent in the patient’s room and 7 percent in the emergency room). In classifying the event, respondents indicated that 24.7 percent resulted from communication failure, 20 percent from an equipment/instrument problem in the operating room, 12.7 percent from improper technique or physician impairment, 8.6 percent from wrong-site surgery and 8.2 percent from medication errors.

Patient-centered care initiative

Frances A. Farley, MD, chair of the Patient-Centered Care Project Team, reported that the AAOS initiative is progressing smoothly, with most projects launched or on their way to implementation. The campaign, themed “Getting better together,” calls for a partnership between orthopaedic surgeons and patients to ensure that patients and their families are informed, respected and involved in all care and treatment decisions.

As part of the campaign, a significant expansion of Your Orthopaedic Connection (YOC), the Academy’s patient education Web site, is planned. A YOC editor is being recruited to oversee a new editorial board. Enhancements to site graphics are in development and new interactive features are planned. A new “Patient-Centered Care” section of the site has already been added, with a link from the YOC home page.

An array of 30- and 60-second radio public service announcements as well as print ads, posters, postcards, a new film on DVD for use in orthopaedists’ waiting rooms and a community awareness PowerPoint presentation on CD have been produced and will be available. The print and radio ads focus on doctor-patient communication and the importance of joint collaboration on health care decisions. The overall 2006 PSA campaign has a patient-centered care focus.

The Communications Skills Mentoring Program, a central element of the member communications aspect of the campaign, continues to expand with 10 more mentors completing their training.

“We are also asking our members to sign an affirmation statement pledging to provide patient-centered care as part of their practice,” Dr. Farley said. “It is important that patients know that their orthopaedic surgeons support patient-centered care and we hope AAOS members will join in this effort. We are asking members to go on the patient-centered care section of the AAOS Web site and record their participation by pledging to provide patient-centered care as part of their practice. And, to help orthopaedists spread the word about patient-centered care, AAOS has also created a free patient-centered care kit.”

PAC had record year

The Political Action Committee (PAC) of the American Association of Orthopaedic Surgeons reached an important milestone in 2005, reported PAC Treasurer William Robb III, MD, by becoming the top fund-raising physician specialty PAC, displacing the anesthesiologists’ PAC. As of December 31, 2005, the PAC had received $1,246,292 from a total of 2,811 contributors. This bested 2004 fund-raising levels, when the PAC received $961,584 in receipts.

During 2005, the Orthopaedic PAC made more than $443,000 in contributions to individuals, leadership and party political action committees, with $100,500 going to the Democrats and $242,500 going to Republicans. Dr. Robb pointed out this should not be perceived as a partisan effort; but rather it just means that more Republicans are in key government leadership positions at present.

Conflict of interest database

Alan M. Levine, MD, chair of the Council on Education, sought input from the Board on a new form of disclosure to be used in education programs—a database open to view by all members. The council previously approved the use of a mandated disclosure database for all educational speakers, a central repository that faculty, authors and others would update at least yearly.

Dr. Levine proposed expanding this database to include disclosure for volunteers serving at all levels within the AAOS. It would be accessible to all members for review and available for use by the AAOS and subspecialty societies. He noted that this represented an initial step in managing, rather than just reporting, on conflicts of interest. It is proactive rather than reactive in approach.

Members would make complete disclosure of all relevant relationships and this information would be included in numerous publications such as the Annual Meeting Final Program, individual books, course syllabi and electronic media programs.

After discussion, the Board decided that, while the conflict of interest database could be expanded in the future, for now it should remain a tool of the Council on Education.

JAAOS Report

William P. Cooney III, MD, editor of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), reported that 2005 was a time of dramatic transition for JAAOS. Dr. Cooney took over as editor and JAAOS moved from bimonthly to monthly publication beginning with its September issue.

Intellectual property rights and responsibilities

The Council on Education sought approval of a new requirement that would alert educational program volunteers to relevant intellectual property issues for their own edification and to help protect the AAOS publishing and CME efforts from copyright infringement suits.

The comprehensive education plan would help all authors and presenters to understand their intellectual property rights and responsibilities. Volunteers would review a learning guide on intellectual property rights, and then take a 10-question test every three years. Upon the recommendation of council chair Alan M. Levine, the Board approved the request.

New Communications Cabinet

Under the new volunteer governance structure, the Council on Communications will be expanded to become the Communications Cabinet. Following an extensive recruitment process, the Committee on Committees nominated Frank B. Kelly, MD, as chairman, and Alan S. Hilibrand, MD, as vice chairman. Richard F. Kyle, MD, current AAOS president who chaired the Committee on Committees while first vice president, presented the nominations and the Board approved them. Dr. Kyle noted that this was the first time a vice chairman was being appointed to an Academy program, reflecting the AAOS desire to build a cadre of experienced leaders for the future.

JBJS Update

James D. Heckman, MD, editor-in-chief of the Journal of Bone and Joint Surgery (JBJS), provided an update on JBJS activities. He noted that 1,278 manuscripts were received and 39 solicited manuscripts were submitted for publication in two supplements (Surgical Techniques Part I and II and the AAOS Selected Scientific Exhibits) published during the year. In addition, 12 AAOS Annual Meeting Instructional Course Lectures were published during 2005.

The overall acceptance rate upon first submission was 17 percent (19 percent for clinical manuscripts, 11 percent for case reports and 19 percent for basic science manuscripts). Articles appearing in the “Orthopaedic Forum,” “Ethics in Practice,” “Topics in Training,” “What’s New” and “Evidence-Based Orthopaedics” have an overall acceptance rate of 80 percent.

The average time from submission to publication for clinical manuscripts was 11.8 months (11.3 months for basic science manuscripts and 11.6 months for case reports). Dr. Heckman pointed out that JBJS continues to provide an opportunity for AAOS members to obtain continuing medical education credit by reading JBJS through both a “paper and pencil” quarterly examination and an electronic version. Last year, more than 1,000 orthopaedic surgeons participated.

Finally, Dr. Heckman said that the online version of the JBJS contains several features not available in the print version. The Web site contains transactions of selected orthopaedic society meetings, a monthly “Image Quiz,” “Letters to the Editor” and electronic supplements to and commentary on articles.

Retiring Board members recognized

Eight individuals retiring from the Boards of Directors or Councils were recognized for their service, including Dr. Farley and Oheneba Boachie-Adjei, MD, who served as members-at-large; Robert W. Bucholz, MD, first past president; James H. Herndon, MD, second past president; Edward A. Toriello, MD, treasurer; Frank B. Kelly, MD, BOC chair; and Mark C. Gebhardt, MD, chair of the Board of Specialty Societies (BOS) (COMSS). In addition, Dr. Hirsch was recognized for his six years of service as chair of the Council on Communications.

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