The Hampshire Hospitals Trauma Prioritisation Tool
J Barrett-Lee, H Fraig, D Avis, T Ardolino
Hampshire Hospitals NHS Foundation Trust
Predicting orthopaedic trauma burden on trusts is often challenging and impacts patient flow. It is recognised that peaks and troughs will occur, and the ideal system would account for this. Practice in many organisations involves using rolling lists to gauge trauma workload, however this is easily underappreciated by management. The prioritisation tool aimed to improve this process, allow greater visualization of workload, and better pre-empt ebbs and flows.
The trauma prioritisation tool comprises three components: injury priority, in-patient workload, and case complexity. Orthopaedic injuries were assigned a ‘fix-time’, according to national guidelines and consultant consensus, representing the time in which fractures should be definitively managed to avoid suboptimal outcomes. Outstanding cases were reviewed daily and ordered using a traffic light system: green – surgery within fix-time, amber – within 72hrs, and red – beyond. An escalation policy was created to trigger one of three responses: 1 – planned trauma cancellation and use of CEPOD, 2 – cancel elective, and 3 – site response.
Following implementation, we saw more efficient responses to surges in trauma and were better able to predict theatre requirements. During new year period 2022, a bed crisis triggered a critical incident and management pushed to amalgamate trauma and CEPOD theatres. A level 3 response was generated, which prevented loss of trauma theatre capacity.
The prioritisation tool improved planning and generated appropriate responses to fluctuating workloads. Consequently, more patients were treated in accordance with national guidelines and demands on the department were better visualised.