ANALYSIS OF SURGICAL PATIENT FLOW AT WINNIPEG HEALTH SCIENCES CENTRE

The Health Sciences Centre (HSC) in Winnipeg is the major trauma centre serving the entire province of Manitoba, Northwestern Ontario, and Nunavut. Therefore, it has to handle a high volume of both elective and emergent surgical patients. Because the facility always strives to provide quality care in a fast and effective manner, it initiated a research project to analyze its surgical patient flow and generate ideas on how it could be redesigned to improve the systems performance. After a year of careful analysis, all of the problems identified were grouped into six major categories, showcasing how various departments are affected by each problem. Based on this analysis, the true impact of each problem in the surgical patient flow process can be understood. Steps can now be taken to identify which problems need to be addressed, what changes should be made, and how this will benefit the entire system.

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Paediatric major incident simulation and the number of discharges achieved using a major incident rapid discharge protocol in a major trauma centre: a retrospective study

BMJ Open ◽

10.1136/bmjopen-2019-034861 ◽

2020 ◽

Vol 10 (12) ◽

pp. e034861

Author(s):

Ruth Bird ◽

Daniel Braunold ◽

Jack Dryburgh-Jones ◽

Jordan Davis ◽

Sam Rogers ◽

...

Keyword(s):

Major Trauma ◽

Discharge Planning ◽

Patient Flow ◽

Patient Discharge ◽

Trauma Centre ◽

Major Incident ◽

Major Trauma Centre ◽

Discharge Policy ◽

Total Capacity ◽

Carbon Copy

ObjectivesHospitals have the responsibility of creating, testing and maintaining major incident (MI) plans. Plans emphasise readiness for acceptance of casualties, though often they neglect discharge planning and care for existing inpatients to make room for the sudden influx.After collaboration and design of a discharge policy for a paediatric MI, we aimed to establish the number of beds made available (primary outcome) to assess potential surge and patient flow. We hypothesised that prompt patient discharge would improve overall departmental flow. Flow is vital for sick patients awaiting admission, for those requiring theatre and also to keep the emergency department clear for ongoing admissions.Method and settingA simulated MI was declared at a London major trauma centre. Five paediatric priority 1 and 15 priority 2 and priority 3 patients were admitted. Using live bed boards, staff initiated discharge plans, and audits were conducted based on hospital bed occupancy and discharge capacity. The patients identified as dischargable were identified and folllowed up for 7 days.ResultsTwenty-nine ward beds were created (42% of the total capacity). Handwritten summaries just took 13.3% of the time that electronic summaries took for the same patients by the same doctor. In-hospital transfers allowed five critically injured children into paediatric intensive care unit (PICU), and creation of a satellite PICU allowed for an additional six more if needed.ConclusionWe increased level 3 capacity threefold and created 40% extra capacity for ward patients. A formalised plan helped with speed and efficiency of safe discharge during an MI. Carbon copy handwritten discharge letters allowed tracking and saved time. Robust follow-up procedures must be in place for any patients discharged.

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MATHEMATICAL PROGRAMMING FOR THE SCHEDULING OF ELECTIVE PATIENTS IN THE OPERATING ROOM DEPARTMENT

Proceedings of the Canadian Engineering Education Association (CEEA) ◽

10.24908/pceea.v0i0.3785 ◽

2011 ◽

Cited By ~ 5

Author(s):

Y. Y. Tan ◽

T. Y. El Mekkawy ◽

Q. Peng ◽

L. Oppenheimer

Keyword(s):

Mathematical Model ◽

Operating Room ◽

Patient Flow ◽

Health Sciences ◽

Surgical Patients ◽

Surgical Patient ◽

Scheduling System ◽

Northwestern Ontario ◽

Extensive Analysis ◽

Using Data

The Health Sciences Centre (HSC) in Winnipeg handles a large portion of the surgical patients in the province of Manitoba, along with Northwestern Ontario, and Nunavut. After an extensive analysis of the surgical patient flow at the facility, it became evident that the Operating Room (OR) scheduling system is one of the major sources of artificial variation in this flow, affecting both the pre and postoperative departments. A two-stage multi-objective mathematical model is proposed for the scheduling of elective cases. Using data obtained from all elective cases actually scheduled during a five week period at the HSC, five weekly OR schedules are generated using the first stage of the proposed mathematical model. The results of the models schedules are compared to current schedules employed at the HSC, to verify its effectiveness and assess the improvements that can be achieved.

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Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318782232 ◽

2018 ◽

Vol 9 ◽

pp. 215145931878223 ◽

Cited By ~ 3

Author(s):

Andrew Davies ◽

Thomas Tilston ◽

Katherine Walsh ◽

Michael Kelly

Keyword(s):

Palliative Care ◽

Femur Fracture ◽

Trauma Centre ◽

Care Plan ◽

X Rays ◽

Neck Of Femur ◽

Early Palliative Care ◽

Multidisciplinary Meeting ◽

Major Trauma Centre ◽

Neck Of Femur Fracture

Background: Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission. Objective: To investigate whether palliative care could be integrated early in the care plan for high-risk patients. Methods: All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input. Results: A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17). Conclusions: Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.

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Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa

The American Surgeon ◽

10.1177/00031348211031855 ◽

2021 ◽

pp. 000313482110318

Author(s):

Victor Kong ◽

Cynthia Cheung ◽

Nigel Rajaretnam ◽

Rohit Sarvepalli ◽

William Xu ◽

...

Keyword(s):

South Africa ◽

Small Bowel ◽

Large Bowel ◽

Major Trauma ◽

Stab Wound ◽

Length Of Hospital Stay ◽

Trauma Centre ◽

Major Trauma Centre ◽

The Mean ◽

Overall Mortality

Introduction Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy. Methods A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa. Results A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%. Conclusions The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.

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592 Surgical Management of Open Tibia Fractures at A Major Trauma Centre: A Review of Cases Over A One-Year Period

British Journal of Surgery ◽

10.1093/bjs/znab134.153 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Khajuria

Keyword(s):

Soft Tissue ◽

Surgical Management ◽

Open Fracture ◽

Major Trauma ◽

Trauma Centre ◽

Soft Tissue Coverage ◽

Internal Stabilization ◽

Major Trauma Centre ◽

Tibia Fractures ◽

One Year

Abstract Introduction The BOAST/BAPRAS updated the open fracture guidelines in December 2017 to replace BOAST 4 Open fracture guidelines; the changes gave clearer recommendations for timing of surgery and recommendations for reducing infection rates. Method Our work retrospectively evaluates the surgical management of open tibia fractures at a Major Trauma Centre (MTC), over a one-year period in light of key standards (13,14 and 15 of the standards for open fractures). Results The vast majority of cases (93%) had definitive internal stabilization only when immediate soft tissue coverage was achievable. 90% of cases were not managed as ‘clean cases’ following the initial debridement. 50% of cases underwent definitive closure within 72 hours. The reasons for definitive closure beyond 72hours were: patients medically unwell (20%), multiple wound debridement’s (33%) and no medical or surgical reason was clearly stated (47%). Conclusions The implementation of a ‘clean surgery’ protocol following surgical debridement is essential in diminishing risk of recontamination and infection. Hence, this must be the gold standard and should be clearly documented in operation notes. The extent of availability of a joint Orthoplastic theatre list provides a key limiting step in definitive bony fixation and soft tissue coverage of open tibia fractures.

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