Trauma Via Day Surgery – Can We Free Up More Inpatient Beds?

O Townsend, S Abouzied, M Mahmoud, L Venkatachalam, S Stapley

Queen Alexandra Hospital, Portsmouth

The volume of trauma is increasing as population demographics evolve, and inpatient bed capacity is squeezed from a variety of influences. We undertook to evaluate our current use of Day Surgery for the management of Orthopaedic trauma, with a view to streamlining processes to improve inpatient bed capacity for other orthopaedic work.

Electronic theatre databases were interrogated for all orthopaedic trauma cases performed in 2022. Adult patients admitted through Day Surgery Unit were identified, and data were collected on time of admission, date and time of discharge, operation performed and reason for failed day case discharge.

2430 trauma cases were identified, of which 513 cases were brought in for attempted day case management (21.1%). These were overwhelmingly upper limb cases, particularly hand and wrist procedures, with ankle fracture ORIF the most common lower limb day case procedure.
Of these 513 cases, 430 were treated and discharged home the same day (83.8%). 83 patients required at least one night in hospital (16.2%). Of those with recorded reason for failure to discharge the same day, uncontrolled pain was the primary reason. Of those discharged the same day, over half were discharged out of hours (after 5pm).

Although over 20% of trauma can already be considered for day case management, there may be scope to increase this. Pathways need refining to reduce ‘failed discharge’ rates of almost 1 in 6 patients. This is likely to require improved analgesia prescribing protocols and efficient trauma list scheduling.