Urgent and planned orthopaedic surgery at Imperial College Healthcare NHS Trust

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Orthopaedic surgery

• Management of fractures and degenerative disease of bones and joints e.g. ankles (29%), hips (23%), arms and shoulders (20%), legs (10%), and spinal injuries (8%).

• Operations are generally:

Planned e.g. hip/knee replacements for osteoarthritis; or Urgent e.g. trauma causing disrupted bone/soft tissue or bone

crumbling

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Orthopaedic surgery at ICHT

• Orthopaedic surgery accounts for only 7% of the 52,000 planned operations and 7.5% of the 20,000 urgent operations performed each year at Charing Cross and St Mary’s Hospitals

Figures for Ealing residents in brackets

Day case / admitted 2009/10

Planned surgery Urgent surgery Outpatients

Charing Cross 1,910 (109) 740 (78) 20,000

St Mary’s 1,670 (469) 760 (15) 19,500

Total 3,580 1,500 39,500

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• Efficiency: increased demands

• Older, heavier population needing orthopaedic procedures

• Treating planned care patients in 18 weeks is more challenging

• Quality: Separate facilities for planned and urgent care are recommended by Royal College of Surgeons:

• reduce infection rates such as MRSA

• improves care – surgeons specialising in certain types of operations

• planned ops are not cancelled by urgent work

• urgent work not delayed by planned work

• facilitates training and research – more patients in trials

Case for change – efficiency and quality

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Case for change – specific to ICHT

• Major Trauma Centre geared up with trauma specialist orthopaedic consultant input. All urgent orthopaedic care on one site would facilitate timely treatment by specialist staff – improve outcomes

• Day case facility larger capacity at Charing Cross than St Mary’s. If planned care all at CXH would allow greater proportion of day cases – reduced infection rates, more patient friendly.

• Achieving single sex accommodation at both sites will be easier (no need for separation of elective and trauma for both sexes each site)

• Continuation with current inefficiencies make the service uneconomic.

• Various options considered by clinicians

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Preferred options with most benefits

1. Planned surgery at CXH and urgent surgery at St Mary’s– More day care (CXH day unit) – achieving better care and savings

– Enables a critical mass of specialist orthopaedic trauma surgeons at StM

– No conflict between elective and urgent duties

– Most cost effective option: £1.2m capital

– Clinicians’ preferred option

2. Planned surgery at CXH but urgent at CXH and SMH– More day care (CXH day unit) and improves planned care

– Small capital cost

– But does not improve urgent care

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What does not need to change?

• The 40,000 outpatient appointments should, and will, continue unchanged on both sites – there is no advantage to changing their location

• The fracture clinics on each site should, and will, continue unchanged

• Urgent medical and surgical services at Charing Cross including HDU/ITU will remain unchanged