James Cook University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom.
James Cook University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom.
Injury. 2023 Jun;54(6):1588-1594. doi: 10.1016/j.injury.2023.03.032. Epub 2023 Mar 24.
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.
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.
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%).
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.
矫形外科：日间创伤是一项在四个国家开展的日间创伤手术多中心前瞻性服务评估。它对损伤负担、患者路径、手术室容量、手术时间和取消情况进行了流行病学评估。这是对全国范围内日间创伤流程和系统性能的首次评估。
通过合作的方式前瞻性地记录数据。第 1 部分每周记录病例量负担和手术室容量。第 2 部分详细记录患者和损伤人口统计学特征，以及特定损伤组的手术时间。纳入 2022 年 8 月 22 日至 10 月 16 日期间安排手术且于 2022 年 10 月 31 日前进行手术的患者。本分析中排除了手部和脊柱损伤。
从 86 个数据访问组（英格兰 70 个，威尔士 2 个，苏格兰 10 个，北爱尔兰 4 个）获得了数据。排除后，分析了代表 23138 例手术的 709 周数据。日间创伤患者（DCTP）占总体创伤负担的 29.1%，占普通创伤列表容量的 25.7%。他们主要是 18 至 59 岁的成年人（56.7%），上肢受伤（65.7%）。在四个国家中，每周提供的日间创伤列表中位数为 0（IQR 1）。6 家/84 家（7.1%）医院每周至少有 5 个日间创伤列表。日间病例的取消率（13.2%）和升级为择期手术列表的比例（9.1%）高于住院患者（分别为 11.9%和 3.4%）。对于同等损伤，日间创伤患者等待手术的时间更长。桡骨远端和踝关节骨折的手术中位时间均在国家推荐范围内：分别为 3 天和 6 天。手术的门诊途径各不相同。英格兰和威尔士常见的主导途径（>50%的患者在该次就诊中被列入名单）并不常见，但最常见的是将患者列入急诊科，80 家医院中的 16 家（20%）。
日间创伤患者管理和资源可用性之间存在显著不匹配。日间创伤患者的手术途径也存在相当大的差异。适合日间手术的患者通常被作为住院患者进行管理。改进日间创伤服务可减轻普通创伤列表的负担，本研究表明，服务和途径的发展以及改善患者体验有很大的空间。
