Scheduled Emergency Trauma Operation: The Green Line Orthopedic Trauma Surgery Process Of Care

Abstract

Background and Aims: Traditionally, patients requiring an orthopedic emergency operation were admitted to an inpatient ward to await surgery. This often led to congestion of wards and operation rooms while, for less urgent traumas, the time spent waiting for the operation often became unacceptably long. The purpose of this study was to evaluate the flow of patients coded green in a traffic light–based coding process aimed at decreasing the burden on wards and enabling a scheduled emergency operation in Central Finland Hospital. Materials and Methods: Operation urgency was divided into three categories: green (>48 h), yellow (8–48 h), and red (<8 h). Patients, who had sustained an orthopedic trauma requiring surgery, but not inpatient care (green), were assigned an operation via green line process. They were discharged until the operation, which was scheduled to take place during office hours. Results: Between January 2010 and April 2015, 1830 green line process operations and 5838 inpatient emergency operations were performed. The most common green line process diagnoses were distal radial fracture (15.4% of green line process), (postoperative) complications (7.7%), and finger fractures (4.9%). The most common inpatient emergency operation diagnosis was hip fracture (24.3%). Green line process and inpatient emergency operation patients differed in age, physical status, diagnoses, and surgical procedures. Conclusion: The system was found to be a safe and effective method of implementing orthopedic trauma care. It has the potential to release operation room time for more urgent surgery, shorten the time spent in hospital, and reduce the need to operate outside normal office hours.

Adverse events are not increased by controlled delay in surgery of acute upper extremity fractures

“…Moreover, inpatient time in the hospital ward was significantly lower in the delayed group than other groups. This decrease in inpatient time was expected, as patients whose operative treatment is delayed are healthier, are likely to have less severe injuries and do not wait for their operation as inpatients but are discharged home to wait for their operation after the decision to opt for operative treatment has been taken 4 .…”

“…Patients who needed inpatient treatment, for example due to complicated pain medication, but did not have other reasons for needing more urgent procedures were coded yellow. For patients able to return home to wait for the operation with sufficient pain medication, and for whom fracture immobilization was available and who had no associated injuries, were usually coded green 4 .…”

Strategies of Osteosynthesis: Problems and Perspectives

“…Проблема решается введением дополнительных хирургических бригад и даже работой в ночное время. В то же время в последние годы отмечено, что операции в ночное время увеличивают риск осложнений, стоимость лечения и риск потери здоровья сотрудниками стационаров [10].…”

“…Качество и безопасность оперативного лечения, выполненного дежурным персоналом, ниже, чем операций, выполненных в дневное время хирургами, которые не дежурили в предыдущую ночь [12,13]. В связи с этим светофорная система позволяет выделить приоритетные операции (проксимальный отдел бедренной кости) и менее экстренные операции, которые вносятся в операционный план и выполняются в дневное время в специализированных операционных опытными хирургами [10].…”