A Dedicated Orthopaedic Trauma Operating Room Improves Efficiency at a Pediatric Center

Brusalis, Christopher M.; Shah, Apurva S.; Luan, Xianqun; Lutts, Meaghan; Sankar, Wudbhav N.

doi:10.2106/jbjs.16.00640

Cited by 30 publications

(31 citation statements)

References 12 publications

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“…time constraints) to perform all of these procedures during the week. Additional dedicated orthopaedic trauma operating rooms in the US have created enormous cost reductions and increased capacity to address the orthopaedic trauma burden [9]. As such, increasing the number of orthopaedic operating rooms may reduce operating theater burden and improve overall surgical capacity at KCMC.…”

Section: Discussionmentioning

confidence: 99%

Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Rajaguru

Jusabani

Massawe

et al. 2019

glob health res policy

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BackgroundAccess to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.MethodsThe 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed.ResultsIn 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients).ConclusionWhile surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.

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Section: Discussionmentioning

confidence: 99%

Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Rajaguru

Jusabani

Massawe

et al. 2019

glob health res policy

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“…From the first to the second halves of their respective rotations, the rate of decision-making errors and technical errors decreased for both group 1 and group 2 residents while maintaining a low overall complication rate of 3.4%, comparable to rates described for other pediatric orthopedic trauma scenarios (2.4%-5.1%). 11 To the best of our knowledge, our study is the first orthopedic surgery-specific report to assess methods to ensure patient safety while promoting resident learning and autonomy. Previous projects aiming to promote resident autonomy have been described in general surgery.…”

Section: Discussionmentioning

confidence: 99%

Implementation of an Orthopedic Trauma Program to Safely Promote Resident Autonomy

Yang

Waters

2019

Journal of Graduate Medical Education

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Background There is ongoing tension in graduate medical education between progressive resident autonomy with entrustable professional activities and the need for supervision to ensure patient safety. Objective We implemented a pediatric orthopedic surgical trauma safety program that utilized a postcall review conference to provide residents graduated responsibility learning opportunities during overnight trauma call without compromising patient safety. Methods In the program, all orthopedic trauma cases seen in our main tertiary hospital emergency department by the overnight orthopedic resident were reviewed in a case conference. For 1 year, we performed an analysis of all fracture patients who were treated in the emergency department by our orthopedic surgery residents. From June 1, 2016, through June 30, 2017, all care delivery encounters were reviewed for decision-making errors, technical errors, and complication rates. Two resident groups rotated through our institution over the course of the study. Results During the year of analysis, all 1298 fracture patients seen overnight in the main tertiary hospital emergency department were reviewed. From the first to the second halves of their rotations, the rate of resident decision-making errors (3.1% [12 of 385] to 2.3% [9 of 399]) and technical errors (9.1% [35 of 395] to 7.3% [29 of 399]) decreased. Excluding decision-making and technical errors, the complication rate for patients discharged home was 3.4% (27 of 784). Conclusions Residents demonstrated decreased decision-making and technical error rates on overnight call while maintaining low complication rates.

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“…Trauma patients—those being any orthopaedic patient requiring non‐elective surgery—often experience delays in surgery due to overfilled general emergency lists and a lack of a dedicated orthopaedic trauma lists (TLs). Frequently, trauma cases are added on to the end of elective lists or alternatively performed after hours on general emergency lists 2,3 . Further delays might also occur as a result from complex or emergency cases 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Further delays might also occur as a result from complex or emergency cases 4 . As a result, operations are often conducted out of hours, which in conjunction with trauma surgery has the potential for worse outcomes and high mortality 2,3,5 . Presenting orthopaedic patients are often triaged at a lower category compared to obstetric and general surgery patients, and thus, their surgery will frequently be postponed to make room for more urgent cases, 6 which in turn usually results in longer LOS 2 …”

Section: Introductionmentioning

confidence: 99%

“…To combat this problem, the establishment of a TL has been shown to be effective in reducing adverse effects for patients through improved theatre efficiency and surgeon schedules, as well as flow‐on effects such as disruption to elective surgeries and outpatient clinics 2,3,7,8 . Using a TL ensures that there is theatre space available (ie unbooked) for trauma cases as they present to the hospital, resulting in less wait time in particular for non‐urgent cases in addition to ensuring space is available during regular working hours 3,7 …”

Section: Introductionmentioning

confidence: 99%

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Introducing an orthopaedic trauma list to a regional hospital: Improved efficiencies and patient outcomes

Thompson

Seghol

Davis

et al. 2021

Australian J Rural Health

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Problem The lack of dedicated theatre time for orthopaedic surgeries at a small rural hospital meant that operations were regularly performed after hours as well as on weekends. Design Retrospective observational audit. Setting Data were collected for 317 patients admitted for trauma surgery between August 2019 and March 2020 at Shoalhaven District Memorial Hospital, which has an orthopaedic service and acts as a referral hospital for a 4561‐km2 catchment on the South Coast of New South Wales. Key measures for improvement Decreased time to surgery, length of stay and proportion of after‐hours operating. Strategies for change To quantify patient outcomes demonstrating effectiveness of the trauma list in theatre operations at the hospital, providing evidence for adequate provision of care at the rural location A reduction in out‐of‐hours operations results in a significant financial saving to the hospital, as well as increased safety to patients. Effects of change Significantly more operations were performed before 16:00 hours as well as on a weekday. Trauma list patients have a shorter length of stay (4.82 vs 7.8 days). Patients prior to the trauma list waited on average 89 hours for surgery, whereas patients on the trauma list waited only 43 hours. Lessons Learnt A dedicated, twice‐weekly orthopaedic trauma list is able to significantly reduce after hours and weekend surgeries. Patients placed on the trauma list had a significantly shorter length of stay and time to surgery. We therefore recommend the usage of dedicated trauma lists at small, regional sites not just to achieve cost savings but also to improve the patient journey and keep patients closer and returning to the home sooner.

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A Dedicated Orthopaedic Trauma Operating Room Improves Efficiency at a Pediatric Center

Abstract: A dedicated orthopaedic trauma operating room in a pediatric trauma center was associated with fewer after-hours procedures, decreased wait time to the surgical procedure, reduced length of hospitalization, and decreased cost.

Cited by 30 publications

References 12 publications

Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Implementation of an Orthopedic Trauma Program to Safely Promote Resident Autonomy

Introducing an orthopaedic trauma list to a regional hospital: Improved efficiencies and patient outcomes

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