Session I - Polytrauma

Thurs., 10/5/06 Polytrauma, Paper #3, 2:27 pm

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

John. J. Wixted, MD (n); Mark A. Reed, MD (*); Bryce Millar, MD (n); Richard C. Anderson, MD (n); Kaushik Bagchi, MD (n);
Shubjeet Kaur, MD (*); Walter J. Leclair, MD (n);
University of Massachusetts Medical Center, Boston, Massachusetts, USA

Purpose: Hospitals must make choices about allocating resources, including operating room time, while balancing the needs of patients, surgeons, and other operating room staff. The purpose of this study is to examine the effect of establishing a dedicated operating room for unscheduled orthopaedic cases. The frequency of after-hours surgery and the impact on a subset of patients with isolated femur fractures treated by intramedullary nailing is reviewed.

Methods: A retrospective review of all orthopaedic cases from the operating room scheduling system at a level I trauma center was undertaken from October 2003 to September 2005. Prior to October 2004, unscheduled cases were placed on a shared add-on list and no special priority was given to orthopaedic cases. Beginning in October 2004, from Monday to Thursday an operating room was assigned to a single orthopaedic trauma surgeon who was given discretion regarding the scheduling of all cases for that room. After a 2-month trial period, the program was extended to include Monday to Friday. All orthopaedic cases from October 2003 to September 2004 (FY04) were examined, and compared to those from October 2004 to September 2005 (FY05). Variables of interest include case start time, procedure, attending surgeon, day of the week, and hospital trauma activation data during the study period. Additionally, a subset of adult patients with isolated femoral shaft fractures was identified to evaluate time from admission to surgery, operative time, frequency of transfer of care between surgeons, and total length of hospital stay.

Results: During the period in question, the orthopaedic trauma staff increased from 2 active surgeons to 4 active surgeons. The number of orthopaedic cases in FY04 was 1799. Total orthopaedic cases in FY05 was 2046, an increase of 14%. Overall, the hospital experienced an increase in level I trauma activations from 1450 in FY04 to 1580 in FY05 (9%), and an increase in the number of trauma patients taken to the operating room from 447 to 494 (10.5%). Cases starting after 7:00 pm declined from 197 in FY04 to 165 in FY05, a decrease of 16%. Cases started between midnight and 7:00 am declined from 63 in FY04 to 35 in FY05, a decrease of 44%. For the subset of femur fracture patients, transfer of care to another operating surgeon occurred 4.5 times more frequently. The median delay between admission and surgery increased from 5.7 hours to 10.9 hours. Median case duration increased from 1.8 hours to 2.1 hours.

Conclusions: It is possible to dramatically decrease the occurrence of after-hours orthopaedic surgery in a level I trauma center. This is likely a multifactoral effect facilitated by having a dedicated room for unscheduled orthopaedic trauma cases. Benefits include less frequent activation of after-hours operating room resources, fewer disruptions to the elective procedure schedule and surgeon's office hours, and more frequent fracture care by orthopaedic trauma specialists. The impact of a longer delay between admission and surgical treatment and more frequent transfer of care between surgeons deserves further evaluation.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.