The impact of major trauma centre designation on routine orthopaedic trauma care

Trauma ◽  
2021 ◽  
pp. 146040862199055
Author(s):  
James Archer ◽  
Abdulrahman Odeh ◽  
Danielle Piper ◽  
Ellen Moore ◽  
Annisa Butt ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Trauma Care ◽  
Major Trauma ◽  
Trauma Centre ◽  
Current Evidence ◽  
Wait Times ◽  
Hip Fracture Surgery ◽  
Major Trauma Centre ◽  
The Impact ◽  
Fracture Surgery

Introduction Major Trauma networks were introduced in 2012 to improve care for patients with major traumatic injuries. Current evidence suggests that this has been successfully achieved, however, there are implications for ‘routine trauma care’ of patients who attend a major trauma centre. Methods We assessed time from injury to surgery in August to October in 2011 and 2019. We also assessed the National Hip Fracture Database outcomes for time to surgery for hip fracture patients. Results Average wait times for ankle surgery increased from 4.9 days (18 patients) in 2011 to 7.0 in days (26 patients) in 2019, whilst for distal radius fracture surgery increased from 3.9 days (36 patients) to 6.5 days (23 patients); the percentage of patients who received their hip fracture surgery within the recommended 36 hours was 53.7% in 2011 (322 patients) compared to 66.7% in 2019 (375 patients). Conclusion The wait times for ‘routine trauma care’ have increased since the introduction of the major trauma network. This is probably due to the large demand on major trauma centres presented by complex trauma patients. However, the number of patients undergoing hip fracture surgery within 36 hours has improved, probably driven by the NHS tariff for hip fracture care. Changes to the current major trauma system or an increase in resources are required to help reverse this trend.

scholarly journals Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Pincus ◽  
Jessica Widdifield ◽  
Karen S. Palmer ◽  
J. Michael Paterson ◽  
Alvin Li ◽  
...  
Keyword(s):  
Time Series ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Wait Times ◽  
Hospital Funding ◽  
Hip Fracture Surgery ◽  
After Hours ◽  
Fracture Surgery

Abstract Background Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery. Methods This was a population-based, interrupted time series analysis of 49,097 surgeries for hip fractures, 10,474 for ankle fractures, 1,594 for tibial plateau fractures, and 40,898 for appendectomy at all hospitals in Ontario, Canada between April 2012 and March 2017. We used segmented regression analysis of interrupted monthly time series data to evaluate the impact of funding reform enacted April 1, 2014 on wait time for hip fracture repair (from hospital presentation to surgery) and after-hours provision of surgery (occurring between 1700 and 0700 h). To assess potential adverse consequences of the reform, we also evaluated two control procedures, ankle and tibial plateau fracture surgery. Appendectomy served as a non-orthopedic tracer for assessment of secular trends. Results The difference (95 % confidence interval) between the actual mean wait time and the predicted rate had the policy change not occurred was − 0.46 h (-3.94 h, 3.03 h) for hip fractures, 1.46 h (-3.58 h, 6.50 h) for ankle fractures, -3.22 h (-39.39 h, 32.95 h) for tibial plateau fractures, and 0.33 h (-0.57 h, 1.24 h) for appendectomy (Figure 1; Table 3). The difference (95 % confidence interval) between the actual and predicted percentage of surgeries performed after-hours − 0.90 % (-3.91 %, 2.11 %) for hip fractures, -3.54 % (-11.25 %, 4.16 %) for ankle fractures, 7.09 % (-7.97 %, 22.14 %) for tibial plateau fractures, and 1.07 % (-2.45 %, 4.59 %) for appendectomy. Conclusions We found no significant effects of a targeted hospital funding model based on fixed price and volume on wait times or the provision of after-hours surgery. Other approaches for improving hip fracture wait times may be worth pursuing instead of funding reform.

scholarly journals Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada

2018 ◽  
Vol 190 (23) ◽  
pp. E702-E709 ◽  
Author(s):  
Daniel Pincus ◽  
David Wasserstein ◽  
Bheeshma Ravi ◽  
James P. Byrne ◽  
Anjie Huang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Wait Times ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals The impact of Major Trauma Centre (MTC) status on paediatric orthopaedic service delivery – 1 year after MTC status designation.

2013 ◽  
Vol 11 (7) ◽  
pp. 566
Author(s):  
Assad Farooq ◽  
Ravindran Visagan ◽  
Yaser Jabber ◽  
Raj Bhattacharya ◽  
Sally Tennant ◽  
...  
Keyword(s):  
Service Delivery ◽  
Major Trauma ◽  
Trauma Centre ◽  
Major Trauma Centre ◽  
Paediatric Orthopaedic ◽  
The Impact

The impact of alcohol intoxication in patients admitted due to assault at an Australian major trauma centre: a trauma registry study from 1999 to 2009

2013 ◽  
Vol 31 (5) ◽  
pp. 390-393 ◽  
Author(s):  
Michael M Dinh ◽  
Kendall J Bein ◽  
Susan Roncal ◽  
Alexandra L C Martiniuk ◽  
Soufiane Boufous
Keyword(s):  
Major Trauma ◽  
Trauma Registry ◽  
Alcohol Intoxication ◽  
Trauma Centre ◽  
Registry Study ◽  
Major Trauma Centre ◽  
The Impact

scholarly journals Predictors of direct home discharge following fractured neck of femur

2017 ◽  
Vol 99 (6) ◽  
pp. 444-451 ◽  
Author(s):  
O Salar ◽  
PN Baker ◽  
DP Forward ◽  
BJ Ollivere ◽  
N Weerasuriya ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Trauma Centre ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Mental Test Score ◽  
Hip Fracture Surgery ◽  
Home Discharge ◽  
Walking Aids ◽  
Major Trauma Centre ◽  
Alternative Location

INTRODUCTION Direct home discharge (DHD) following hip fracture surgery represents a challenging proposition. The aim of this study was to identify factors influencing the discharge destination (home vs alternative location) for patients admitted from their own home with a fractured neck of femur. METHODS A retrospective cohort study of prospectively collected major trauma centre data was performed, identifying 10,044 consecutive hip fracture admissions between 2000 and 2012. RESULTS Two-thirds of the patients (n=6,742, 67%) were admitted from their own home. Half of these (n=3,509, 52%) returned directly to their own home while two-fifths (n=2,640, 39%) were discharged to an alternative location; 593 (9%) died. The following were identified as independent variables associated with a higher likelihood of DHD: younger patients, female sex, an abbreviated mental test score of 10, absence of certain co-morbidities, cohabiting, walking independently outdoors, no use of walking aids, no assistance required with basic activities of daily living and intracapsular fracture. CONCLUSIONS Identifying those at risk of being discharged to an alternative location following admission from home on the basis of identified preoperative indices could assist in streamlining the postoperative care phase. Pre-emptive action may help increase the numbers of patients discharged directly home and reduce the number requiring additional rehabilitation prior to discharge home with its associated socioeconomic effect.

scholarly journals 257 The Effect of the COVID-19 Pandemic on Mental Health Associated Trauma, Admissions and Fractures at a London Major Trauma Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M S Jamal ◽  
D Hay ◽  
K Al-Tawil ◽  
A Petohazi ◽  
V Gulli ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Diagnosis ◽  
Major Trauma ◽  
Mental Health Problems ◽  
Demographic Data ◽  
Trauma Centre ◽  
Related Factors ◽  
Number Of Patients ◽  
Major Trauma Centre ◽  
The Impact

Abstract Aim Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results here were 824 Orthopaedic referrals and 358 admissions (6/day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.

scholarly journals Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

2020 ◽  
Author(s):  
Debkumar Chowdhury ◽  
P. Okoh ◽  
H. Dambappa
Keyword(s):  
Major Trauma ◽  
Significant Proportion ◽  
Fragility Fractures ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Analgesic Requirement ◽  
Multiple Rib Fractures ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

scholarly journals The impact of trauma centre designation on open tibial fracture management

2013 ◽  
Vol 95 (3) ◽  
pp. 184-187 ◽  
Author(s):  
J Stammers ◽  
D Williams ◽  
J Hunter ◽  
M Vesely ◽  
D Nielsen
Keyword(s):  
Major Trauma ◽  
Average Length ◽  
Trauma Centre ◽  
Tibial Fractures ◽  
Open Tibial Fractures ◽  
Major Trauma Centre ◽  
Fracture Management ◽  
Before And After ◽  
Trauma Networks ◽  
The Impact

Introduction The British Orthopaedic Association/British Association of Plastic, Reconstructive and Aesthetic Surgeons guidelines for the management of open tibial fractures recommend early senior combined orthopaedic and plastic surgical input with appropriate facilities to manage a high caseload. The aim of this study was to assess whether becoming a major trauma centre has affected the management of patients with open tibial fractures. Methods Data were obtained prospectively on consecutive open tibial fractures during two eight-month periods: before and after becoming a trauma centre. Results Overall, 29 open tibial fractures were admitted after designation as a major trauma centre compared with 15 previously. Of the 29 patients, 21 came directly or as transfers from another accident and emergency deparment (previously 8 of 15). The time to transfer patients admitted initially to local orthopaedic departments has fallen from 205.7 hours to 37.4 hours (p=0.084). Tertiary transferred patients had a longer hospital stay (16.3 vs 14.9 days) and had more operations (3.7 vs 2.6, p=0.08) than direct admissions. As a trauma centre, there were improvements in time to definitive skeletal stabilisation (4.7 vs 2.2 days, p=0.06), skin coverage (8.3 vs 3.7 days, p=0.06), average number of operations (4.2 vs 2.3, p=0.002) and average length of hospital admission (26.6 vs 15.3 days, p=0.05). Conclusions The volume and management of open tibial fractures, independent of fracture grade, has been directly affected by the introduction of a trauma centre enabling early combined senior orthopaedic and plastic surgical input. Our data strongly support the benefits of trauma centres and the continuing development of trauma networks in the management of open tibial fractures.

scholarly journals Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre

2020 ◽  
Vol 9 (1) ◽  
pp. e000550
Author(s):  
Alex Peter Magnussen ◽  
Christopher Watura ◽  
Nicola Torr ◽  
Miny Walker ◽  
Dimitri Amiras ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Delayed Diagnosis ◽  
Trauma Centre ◽  
Current Evidence ◽  
Shoulder Injury ◽  
Posterior Shoulder ◽  
Major Trauma Centre ◽  
Fracture Dislocations ◽  
Axial View

BackgroundA high incidence of missed posterior shoulder dislocations is widely recognised in the literature. Concern was raised by the upper limb multidisciplinary team at a London major trauma centre that these missed injuries were causing serious consequences due to the need for surgical intervention and poor functional outcome.ObjectiveTo identify factors contributing to missed diagnosis and propose solutions.MethodsA local quality improvement report was performed investigating time from admission to diagnosis of simple posterior dislocations and fracture dislocations over a 5-year period. Factors contributing to a delayed diagnosis were analysed.ResultsThe findings supported current evidence: a posterior shoulder dislocation was more often missed if there was concurrent fracture of the proximal humerus. Anteroposterior and scapular Y view radiographs were not always diagnostic for dislocation. Axial views were more reliable in assessment of the congruency of the joint and were associated with early diagnosis and appropriate treatment of the injury.DiscussionAs a result of these findings a new protocol was produced by the orthopaedic and radiology departments and distributed to our emergency department practitioners and radiography team. The protocol included routine axial or modified trauma axial view radiographs for all patients attending the emergency department with a shoulder injury, low clinical suspicion for dislocation and a low threshold for CT scan. Reaudit and ongoing data collection have shown significant increase in axial view radiographs and improved diagnosis.

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