James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW, United Kingdom.
James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW, United Kingdom.
Injury. 2023 Dec;54(12):111007. doi: 10.1016/j.injury.2023.111007. Epub 2023 Aug 22.
Current practice following injury within the United Kingdom is to receive surgery, at the institution of first contact regardless of ability to provide timely intervention and inconsiderate of neighbouring hospital resource and capacity. This can lead to a mismatch of demand and capacity, delayed surgery and stress within hospital systems, particularly with regards to elective services. We demonstrate through a multicentre, multinational study, the impact of this at scale.
ORTHOPOD data collection period was between 22/08/2022 and 16/10/2022 and consisted of two arms. Arm 1 captured orthopaedic trauma caseload and capacity in terms of sessions available per centre and patients awaiting surgery per centre per given week. Arm 2 recorded patient and injury demographics, time of decision making, outpatient and inpatient timeframes as well as time to surgery. Hand and spine cases were excluded. For this regional comparison, regional trauma networks with a minimum of four centres enroled onto the ORTHOPOD study were exclusively analysed.
Following analysis of 11,202 patient episodes across 30 hospitals we found no movement of any patient between hospitals to enable prompt surgery. There is no current system to move patients, between regional centres despite clear discrepancies in workload per capacity across the United Kingdom. Many patients wait for days for surgery when simple transfer to a neighbouring hospital (within 10 miles in many instances) would result in prompt care within national guidelines.
Most trauma patients in the United Kingdom are managed exclusively at the place of first presentation, with no consideration of alternative pathways to local hospitals that may, at that time, offer increased operative capacity and a shorter waiting time. There is no oversight of trauma workload per capacity at neighbouring hospitals within a regional trauma network. This leads to a marked disparity in waiting time to surgery, and subsequently it can be inferred but not proven, poorer patient experience and outcomes. This inevitably leads to a strain on the overall trauma system and across several centres can impact on elective surgery recovery. We propose the consideration of inter-regional network collaboration, aligned with the Major Trauma System.
目前，在英国，受伤后的治疗惯例是在首次接触的机构进行手术，而不考虑提供及时干预的能力，也不考虑邻近医院的资源和能力。这可能导致需求与能力不匹配，手术延迟，并给医院系统带来压力，特别是在择期手术方面。我们通过一项多中心、多国研究证明了这种情况的规模影响。
骨科数据收集期为 2022 年 8 月 22 日至 10 月 16 日，分为两个阶段。第 1 阶段记录了每个中心可提供的手术次数和每个中心每给定周等待手术的患者人数，以评估骨科创伤病例量和能力。第 2 阶段记录了患者和损伤的人口统计学特征、决策时间、门诊和住院时间框架以及手术时间。手部和脊柱病例被排除在外。在这次区域比较中，只分析了至少有 4 个中心加入 ORTHOPOD 研究的区域创伤网络。
对 30 家医院的 11202 例患者病例进行分析后，我们发现没有任何患者在医院之间转移以实现及时手术。尽管英国各地的工作量与能力之间存在明显差异，但目前没有在区域中心之间转移患者的系统。许多患者需要等待数天才能接受手术，而简单地转至附近医院（在许多情况下距离不到 10 英里）就可以根据国家指南提供及时治疗。
英国大多数创伤患者仅在首次就诊的地方接受治疗，而不考虑转至附近可能提供更多手术能力和更短等待时间的医院的替代途径。在区域创伤网络内，没有对邻近医院的创伤工作量与能力进行监督。这导致手术等待时间存在显著差异，因此可以推断但无法证明患者的体验和结果较差。这不可避免地给整个创伤系统带来压力，并可能影响几个中心的择期手术恢复。我们建议考虑区域间网络合作，与主要创伤系统保持一致。
