The Effect of an Orthopedic Trauma Room on After-Hours Surgery at a Level One Trauma Center

Wixted, John J.; Reed, Mark A.; Eskander, Mark S.; Millar, Bryce; Anderson, Richard C.; Bagchi, Kaushik; Kaur, Shubjeet; Franklin, Patricia D.; Leclair, Walter J.

doi:10.1097/bot.0b013e31816c748b

Cited by 58 publications

(54 citation statements)

References 4 publications

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“…As the addition of a trauma room has been shown to dramatically decrease the volume of overnight surgeries and complications, and as the institution of a hip fracture pathway for medical management has been shown to decrease perioperative morbidity, their results might not demonstrate as clear an effect of DTG versus NTG hip fracture repair. [42][43][44][45] In our cohort, institution of a hip fracture pathway as well as provision of a dedicated trauma room occurred prior to data collection, thus eliminating these factors as confounding variables.…”

Section: Discussionmentioning

confidence: 99%

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

Switzer

Bennett

Wright

et al. 2013

Geriatr Orthop Surg Rehabil

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Background: Due to the need for medical optimization and congested operating room schedules, surgical repair is often performed at night. Studies have shown that work done at night increases complications. The primary aim of our study is to compare the rates of complications and 30-day mortality between 2 surgical times of day, daytime group (DTG, 07:00-15:59) and nighttime group (NTG,. Methods: Retrospective chart review from 2005 through 2010. Setting: Level 1 Trauma Center. Participants: 1443 patients with hip fracture, age 50 years with isolated injury and surgical treatment of the fracture. Main Outcomes and Measures: Thirty-day mortality and complications: myocardial infarction, cardiac event, stroke, central nervous system event, pneumonia, urinary tract infection, postoperative wound infection, and bleeding requiring transfusion of 3 or more red blood cell units. Results: A total of 859 patients met the inclusion criteria; 668 patients in the DTG and 191 patients in the NTG. The 30-day mortality was 7.8%. The complication rate was 28%. No difference was found in 30-day mortality or complication rate based on the time of day the surgery was performed (P ¼ 1.0 and P ¼ .92, respectively). This remained unchanged when controlling for health status and surgical complexity. Age (odds ratio ¼ 1.03/year), Charlson Comorbidity Index (CCI; odds ratio ¼ 1.21), and American Society of Anesthesiologists (ASA; odds ratio ¼ 1.85) score were predictive of adverse outcomes. Conclusion: Surgical time of day did not affect 30-day mortality or total number of complications. Age, ASA score, and CCI were associated with adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

Switzer

Bennett

Wright

et al. 2013

Geriatr Orthop Surg Rehabil

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“…The availability of a dedicated daytime trauma operating room is a big help to the efficient running of the whole management process. 17 This trauma operating room caters for all patients that need fracture care and offers several advantages. First is the flexibility of the trauma cases allocated for operation.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of a Geriatric Hip Fracture Clinical Pathway in Reducing Hospital and Rehabilitation Length of Stay and Improving Short-Term Mortality Rates

Lau

Fang

Leung

2013

Geriatr Orthop Surg Rehabil

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Background: A geriatric hip fracture clinical pathway, led by an orthopedic surgeon, was developed in 2007. This clinical pathway team is multidisciplinary and consists of surgeons, physicians, anesthetists, nurses, physiotherapists, occupational therapists, medical social workers, dieticians as well as voluntary support groups. Methods: From early 2007 onward, all patients older than 65 years with acute isolated hip fractures were included. During the whole inpatient treatment, all relevant data were captured prospectively. The data in 2006, before the implementation of the clinical pathway, were collected retrospectively through computer record system. A study of the length of stay in acute and rehabilitation hospital and also the short-term mortality rate was carried out to compare the difference before and after the implementation of the pathway. Results: From 2007 onward, more than 1300 hip fractures were treated. After the implementation of the pathway, the preoperative length of stay was markedly shortened by 4 days, from an average of 6.1 days in 2006 to 1.5 days in 2011 (P < .05). The postoperative length of stay and the overall acute hospital length of stay also improved significantly. The length of stay in rehabilitation hospital was also significantly shorter in the 4-year period. Although the number of hip fractures increased annually with increased age and number of comorbidities each year, the inpatient mortality rate showed a gradual decrease from 2.7% in 2006 to 1.25% in 2010. The 30 days mortality rate also showed a decrease from 3.65% in 2006 to 2.75% in 2010. Conclusion: Geriatric hip fracture clinical pathway is an excellent approach to the geriatric hip fracture service. The most significant improvement is the dramatic shortening of the length of hospital stay. Our success in the past 5 years has proven its value and sustainability.

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“…5 A dedicated OR for unscheduled cases has the potential to reduce competition between elective and emergency surgery, thereby increasing efficiency and improving quality of care. While a few studies have evaluated the benefits of a dedicated OR for emergency surgical patients, these studies have either focused only on a single surgical service (e.g., an orthopedic trauma room 6,7 ) or have used a computer simulation model. 8 The purpose of this study was to evaluate the benefits of a dedicated OR for emergency procedures available to all surgical services at a large children's hospital.…”

Section: Discussionmentioning

confidence: 99%

“…In these situations, a dedicated orthopedic trauma room has been established and has shown benefits such as less afterhours surgery, fewer scheduling disruptions and more frequent fracture care by subspecialty-trained orthopedic traumatologists. 6,7 The advent of integrated emergency/ trauma services in general surgery has led to the creation of a dedicated team of a surgeon and trainees whose sole responsibility is to care for emergent general surgery patients. This allows an assigned surgeon to always be available for emergency cases during the day.…”

Section: Discussionmentioning

confidence: 99%

Dedicated operating room for emergency surgery improves access and efficiency

Heng

Wright

2013

Can J Surg

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Background: Scheduling emergency cases among elective surgeries often results in prolonged waits for emergency surgery and delays or cancellation of elective cases. We evaluated the benefits of a dedicated operating room (OR) for emergency procedures available to all surgical services at a large children's hospital. Methods:We compared a 6-month period (January 2009 to June 2009) preimplementation with a 6-month period (January 2010 to June 2010) postimplementation of a dedicated OR. We evaluated OR use, wait times, percentage of cases done within and outside of access targets, off-hours surgery, cancellations, overruns and length of stay.Results: Preimplementation, 1069 of the 5500 surgeries performed were emergency cases. Postimplementation, 1084 of the 5358 surgeries performed were emergency cases. Overall use of the dedicated OR was 53% (standard deviation 25%) postimplementation. Excluding outliers, the average wait time for priority 3 emergency patients decreased from 11 hours 8 minutes to 10 hours 5 minutes (p = 0.004). An increased proportion of priority 3 patients, from 52% to 58%, received surgery within 12 hours (p = 0.020). There was a 9% decrease in the proportion of priority 3 cases completed during the evening and night (p < 0.001). The elective surgical schedule benefited from the dedicated OR, with a significant decrease in cancellations (1.5% v. 0.7%, p < 0.001) and an accumulated decrease of 5211 minutes in overrun minutes in elect ive rooms. The average hospital stay after emergency surgery decreased from 16.0 days to 14.7 days (p = 0.12) following implementation of the dedicated OR. Conclusion:A dedicated OR for emergency cases improved quality of care by decreasing cancellations and overruns in elective rooms and increasing the proportion of priority 3 patients who accessed care within the targeted time.Contexte : Ajouter des chirurgies urgentes à l'horaire des chirurgies non urgentes prolonge souvent l'attente pour les premières et entraîne des retards ou des annulations pour les secondes. Nous avons évalué les avantages d'un bloc opératoire dédié aux urgences et accessible à toutes les spécialités chirurgicales dans un grand hôpital pédiatrique.Méthodes : Nous avons comparé 2 périodes de 6 mois chacune, soit avant la création du bloc opératoire dédié (de janvier 2009 à juin 2009) et après sa création (de janvier 2010 à juin 2010). Nous avons évalué l'utilisation du bloc opératoire, les temps d'attente, le pourcentage de cas réglés à l'intérieur et à l'extérieur des temps cibles, les chirurgies effectuées en dehors des heures normales, les annulations, les dépassements du temps prévu et la durée des séjours hospitaliers.

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The Effect of an Orthopedic Trauma Room on After-Hours Surgery at a Level One Trauma Center

Cited by 58 publications

References 4 publications

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

The Effectiveness of a Geriatric Hip Fracture Clinical Pathway in Reducing Hospital and Rehabilitation Length of Stay and Improving Short-Term Mortality Rates

Dedicated operating room for emergency surgery improves access and efficiency

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