Two Years Experience of Day Case EmergencyHand Surgery in Birmingham

A. Mahon, M. McCarthy, M.A.C. Craigen, V. Rajaratnam, O.G. Titley, F. Peart, M.A. WaldramThe Birmingham Hand Centre, Selly Oak Hospital, Birmingham, UK.

The Birmingham Hand Centre

Comparison of Hand Cases Perormed

Survey of Patients’ Expections VersusPerceptionof Service Using SERVQUAL Tool

Year 1 Year 201/04/03-31/03/04 01/04/03-31/03/05

In November 2003, a day case emergency hand surgery system wasintroduced to deal with hand trauma at University Hospital, Birmingham.The patients are assessed in the Accident Department by a Senior HouseOfficer or Specialist Registrar on the day of referral, and strict criteria areused to assess eligibility for day case treatment. A Hand Coordinatorliases with patients, surgeons and the ambulatory theatre department toorganise treatment on consultant led dedicated daytime hand lists.Twelve lists per week serve the current referral load.

An escalation policy exists in order to deal with excessive waiting timesor large numbers of patients awaiting surgery. This is triggered whenmore than 8 patients are awaiting surgery or patients wait more than 3days for surgery. Available lists and staff are sought and, when necessary,an additional theatre list will be organised on a weekend or an evening.

The aim of this study was to assess the effect this reorganisation in termsof numbers of patients treated, theatre utilisation and patientsatisfaction.

Introduction

Objectives

Data on patients treated has been collected on a prospective basis.Theatre records were used to assess theatre utilisation. Numbers ofcomplaints were recorded with the assistance of the Patient Advice andLiaison Service (PALS).

Patients and Methods

The number of patients treated in 2003/2004 was 1261 comparedwith1725 in 2004/2005, an increase of 37%. Prior to November 2003,only 4% of patients were treated without inpatient stay, 33% ofpatients were treated in the day surgery unit in 2003/2004, comparedwith 60% in 2004/2005. This amounts to an estimated saving of 1656bed days in 2004/2005. PALS received an average of 4 complaints perweek prior to implementation of the day case protocol and only 3 inthe 2-year period since – a reduction of 99%.

Results

Prior to the implementation of the Day Case Hand Surgery protocol, wefound that the majority of patients referred to our unit were admittedto await surgical treatment. As the majority of such injuries are neitherlife nor limb threatening, they are not seen as a priority for surgery.This frequently results in delayed treatment, beds being occupied bypatients who are receiving nothing more than oral medication, patientdissatisfaction and ultimately, complaints about treatment.

The introduction of dedicated day theatre lists for hand trauma and asenior nurse to coordinate the hand trauma lists and liase with patientshas improved the situation considerably. Although patients may stillwait several days for surgery, they now do so at home. They areinformed at an early stage, when they are likely to undergo surgery andcancellations are rare. This has resulted in greater patient satisfaction asindicated by a 99% reduction in complaints. A prior study carried out inour unit has shown further objective evidence of patient satisfaction byusing the SERVQUAL tool.

Treating hand trauma patients as day cases has not led to an increase incomplications and this may be related to the use of a strict protocol.

The use of an escalation policy at times when the number of patientsrequiring treatment exceeds normal capacity has been successful.

Discussion

The introduction of a hand coordinator led, day case emergency handsurgery protocol has resulted in a marked increase in the number ofpatients treated, and reduced the burden on main theatre. In additionthere is better patient satisfaction. We feel that this is a good modelfor the organisation of a hand trauma service.

Conclusions