ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom

Other collaborators, Royal Victoria Infirmary Local PI, Other collaborators, Salisbury Hospital Local PI, Other collaborators, Sandwell General Hospital Local PI, Other collaborators, Sheffield Teaching Hospitals Local PI, Other collaborators, South Tees Local PI, Other collaborators, Southend University Hospital Local PI, Other collaborators, Southmead Hospital Local PI, Other collaborators, Southport and Ormskirk NHS Trust Local PI, Other collaborators, St. Georges Hospital Local PI, Other collaborators, St. Mary's Hospital Local PIOther collaborators, Stepping Hill Hospital Local PI, Other collaborators, Sunderland Royal Hospital Local PI, Other collaborators, The Royal Hospital for Children, Glasgow Local PI, Other collaborators, The Royal London Hospital Local PI, Other collaborators, Ulster Hospital Local PI, Other collaborators, University Hospital Coventry & Warwickshire Local PI, Other collaborators, University Hospital Crosshouse Local PI, Other collaborators, University Hospital North Durham Local PI, Other collaborators, University Hospital of Wales Local PI, Other collaborators, University Hospital Wishaw Local PI, Other collaborators, Warrington & Halton NHS Teaching Hospitals Local PI, Other collaborators, Watford General Hospital Local PI, Other collaborators, West Suffolk Hospital Local PI, Other collaborators, Whipps Cross Hospital Local PI, Other collaborators, Whiston Hospital Local PI, Other collaborators, Wythenshawe Hospital Local PI, Other collaborators, Yeovil District Hospital Local PI, Other collaborators, ORTHOPOD Collaborators, Aberdeen Royal Infirmary Local PI, Other collaborators, Aintree Hospital Local PI, Other collaborators, Airedale General Hospital Local PI, Other collaborators, Alder Hey Children's Hospital Local PI, Other collaborators, Altnagelvin Area Hospital Local PI, Other collaborators, Arrowe Park Hospital Local PI, Other collaborators, Ashford and St Peter's Hospitals Local PI, Other collaborators, Belfast Children's Hospital Local PI, Other collaborators, Bradford Royal Infirmary Local PI, Other collaborators, Bristol Royal Infirmary Local PI, Other collaborators, Broomfield Hospital Local PI, Other collaborators, Cumberland Infirmary Local PI, Other collaborators, Darent Valley Hospital Local PI, Other collaborators, Darlington Memorial Hospital Local PI, Other collaborators, Derriford Hospital Local PI, Other collaborators, Dumfries and Galloway Royal Infirmary Local PI, Other collaborators, East Surrey Hospital Local PI, Other collaborators, Epsom & St. Helier Hospital Local PI, Other collaborators, Forth Valley Royal Hospital Local PI, Other collaborators, Glasgow Royal Infirmary Local PI, Other collaborators, Gloucestershire Royal Hospital Local PI, Other collaborators, Great Western Hospital Local PI, Other collaborators, Hampshire Hospitals Local PI, Other collaborators, Harrogate and District NHS Foundation Trust Local PI, Other collaborators, Horton General Hospital Local PI, Other collaborators, Ipswich Hospital Local PI, Other collaborators, John Radcliffe Hospital, Oxford Local PI, Other collaborators, Leeds General Infirmary Local PI, Other collaborators, Leicester Royal Infirmary Local PI, Other collaborators, Lister Hospital Local PI, Other collaborators, Maidstone & Tunbridge Wells NHS Trust Local PI, Other collaborators, Morriston Hospital, Swansea Bay Local PI, Other collaborators, Musgrove Park Hospital Local PI, Other collaborators, New Cross Hospital, Wolverhampton Local PI, Other collaborators, Norfolk and Norwich University Hospital Local PI, Other collaborators, Local PI, Other collaborators, North Tees Local PI, Other collaborators, Northampton General Hospital Local PI, Other collaborators, Northumbria Specialist Emergency Care Hospital Local PI, Other collaborator, Nottingham University Hospitals Local PI, Other collaborator, Pinderfields Hospital Local PI, Other collaborator, Princess Alexandra Hospital, Essex Local PI, Other collaborator, QEUH, Glasgow Local PI, Other collaborators, Queen Alexandra Hospital Local PI, Other collaborators, Queen Elizabeth Hospital, Kings Lynn Local PI, Other collaborators, Queen Elizabeth Hospital, Birmingham Local PI, Other collaborators, Queen Elizabeth Hospital, Gateshead Local PI, Other collaborators, Queens Hospital, Derby & Burton Local PI, Rotherham District General Hospital Local PI, Other collaborators, Royal Alexandra Hospital Local PI, Other collaborators, Royal Blackburn Hospital Local PI, Other collaborators, Royal Cornwall Hospital Local PI, Other collaborators, Royal Devon & Exeter Hospital Local PI, Other collaborators, Royal Infirmary of Edinburgh Local PI, Other collaborators, Royal Preston Hospital Local PI, Other collaborators, Royal Shrewsbury Hospital Local PI, Other collaborators, Royal Sussex County Hospital Local PI, Other collaborators, Royal United Hospital Bath Local PI, Other collaborators, Royal Victoria Hospital, Belfast Local PI

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: ORTHOPOD: Day Case Trauma is a multicentre prospective service evaluation of day-case trauma surgery across four countries. It is an epidemiological assessment of injury burden, patient pathways, theatre capacity, time to surgery and cancellation. It is the first evaluation of day-case trauma processes and system performance at nationwide scale. Methods: Data was prospectively recorded through a collaborative approach. Arm one captured weekly caseload burden and operating theatre capacity. Arm two detailed patient and injury demographics, and time to surgery for specific injury groups. Patients scheduled for surgery between 22/08/22 and 16/10/22 and operated on before 31/10/22, were included. For this analysis, hand and spine injuries were excluded. Results: Data was obtained from 86 Data Access Groups (70 in England, 2 in Wales, 10 in Scotland and 4 in Northern Ireland). After exclusions, 709 weeks worth of data representing 23,138 operative cases were analysed. Day-case trauma patients (DCTP) accounted for 29.1% of overall trauma burden and utilised 25.7% of general trauma list capacity. They were predominantly adults aged 18 to 59 (56.7%) with upper limb Injuries (65.7%). Across the four nations, the median number of day-case trauma lists (DCTL) available per week was 0 (IQR 1). 6 of 84 (7.1%) hospitals had at least five DCTLs per week. Rates of cancellation (13.2% day-case; 11.9% inpatient) and escalation to elective operating lists (9.1% day-case; 3.4% inpatient) were higher in DCTPs. For equivalent injuries, DCTPs waited longer for surgery. Distal radius and ankle fractures had median times to surgery within national recommendations: 3 days and 6 days respectively. Outpatient route to surgery was varied. Dominant pathways (>50% patients listed at that episode) in England and Wales were uncommon but the most frequently seen was listing patients in the emergency department, 16 of 80 hospitals (20%). Conclusion: There is significant mismatch in DCTP management and resource availability. There is also considerable variation in DCTP route to surgery. Suitable DCTL patients are often managed as inpatients. Improving day-case trauma services reduces the burden on general trauma lists and this study demonstrates there is considerable scope for service and pathway development and improved patient experience.

Original languageEnglish (US)
Pages (from-to)1588-1594
Number of pages7
JournalInjury
Volume54
Issue number6
DOIs
StatePublished - Jun 2023

Keywords

  • Ambulatory
  • Cancellations
  • Day-case trauma
  • Delays
  • Fracture
  • Time to surgery
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

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