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Copy of Copy of 2013 Hand Trauma Audit

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Samantha Conlin

on 9 October 2014

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Transcript of Copy of Copy of 2013 Hand Trauma Audit

St John's hospital hand trauma audit: reducing inpatient stay.
Dr Samantha Conlin
Dr Peter Hutchison
Miss P. Rust
Cycle 1
May 2011
Authors: Dr Ruth Lawless, Dr Nick Spath and Miss P Rust

In light of the BSSH 2007 report to assess hand surgery provision at SJH

Aims:
Quantify patient load
Identify procedures/adequacy of training
Calculate daycase provision
Results
Cycle 2
Nov 2011
Authors: Dr Tom Carter,
Miss P Rust

Assessed effect of:
3x week hand trauma lists
DOSA semi-elective booking diary
Hand trauma proforma


190 patients over 8 weeks
23/week (from 11/week)
?improved data collection
32% managed through DOSA unit.
46% managed as day case procedures (inpatients + DOSA) from 22%.
Cycle 3
Jun 2012
Authors: Dr Harry Sargeant and Miss P Rust

-to assess effect of c-arm and additional Friday hand list


Results
Friday hand trauma list stopped
FY1 discharge form stopped
New consultant specialist hand surgeon (3 in total).

1
2
3
82 patients over 7 weeks

22% of patients were managed as a day case procedures.
Standard set - 95%!
169 patients over 8 weeks
21/week
32% DOSA (from 32%)
44% managed as daycase (from 46%)
25% entered in booking diary
50% of the Friday slots were used.

Cycle 4
Jan 2013

Methods
Results
299 procedures in 255 patients over 12 weeks
188 hand trauma (15/wk)
DOSA
33% (hand, from 32%)
25% (all trauma)
Daycase
46% (hand, from 44%)
40% (all trauma)
Prospective study over 12 weeks: 31st Dec 2012 to 26th Mar 2013

Comprised all plastics trauma including hand and wrist injuries.

Information obtained using: CEPOD preop list and theatre book; online DOSA booking diary; IDLs and ward admission book.
http://www.ncepod.org.uk/pdf/2003/03_s07.pdf
Standards
1. Assess effect of previous cycles on day case hand trauma procedures (inpatient + DOSA)
2. Recommendations to reduce inpatient stay/increase use of DOSA for all plastics trauma patients
Continued improvement from previous daycase patients (44%) to 60-85% (BSSH 2007/previous cycles)
Improvement in data collection.

Recommendation for circulation of plastics shared drive to all FY1s/SHOs.
New C-arm purchased.
Trial of additional Friday hand trauma list.
Results
Outcome
Discussion
Thank you.
Any questions?
Cycle 4
Background
BSSH 2007 report: Hand Surgery in the UK

Recommendations:
Hand surgery as discrete specialty
Increase day case provision
Dedicated lists and equipment to maximise turnover
Outcome
Surgery day
Operation start time
NCEPOD data operation start time 2003
Gender
Age
2012 Deprivation score
General/local anaesthesia
Injury
Procedure
Source of referral
Inpatient pre-op nights
Total inpatient stay
Are hand lists truly dedicated esp Mon/Tue?
Appropriate move from out of hours work
Fewer inpatient preop days
Time to look at post op?
DOSA use not improving
Limitations
Future work
No record of patients not operated upon.
Unreliable records of cases performed in the treatment room on W18.
Protected hand trauma list: Should it be Mon/Thur/Fri?
Induction to C-arm booking
More use of regional anaesthesia
Access to Orsis for future
audits
DOSA booking diary
Is there a role for a hand unit coordinator to increase DOSA use? (BSSH 2007)
Dedicated senior
and 3 dedicated hand trauma theatre lists per week (1/2 day)
Aims
3 previous cycles > three/week hand lists, online booking diary, c-arm and additional hand consultant.
Inpatient post-op nights
4
Outcome
Cycle 2
Cycle 1
Cycle 3
Cycle 4
Full transcript