Effect of the introduction of an orthopaedic trauma scheme on the lengths of stay after fracture neck of femur

The length of stay in hospital of particular patient groups is an issue frequently looked at by governments when the number of emergency admissions rise and bed management becomes a problem. This linked with the length of time that patients spend on trolleys in the Accident and Emergency Department, one of the key indicators used by the government to measure the success of a hospital, gave rise to this study. This study describes an evaluative research project undertaken at one inner London NHS Trust, which introduced an orthopaedic trauma scheme for patients with fractured neck of femur. The objective of this research was to discover whether the introduction of an orthopaedic trauma scheme had an impact on the care and management and length of stay of patients sustaining a fractured neck of femur. The research design used was an evaluative comparison survey study. Cohorts of patients were studied before and after the establishment of the trauma scheme and the periods of study took place during the same annual period of two consecutive years to coincide with the potential seasonal activities. The participants were a convenience sample from a known population. They were all patients present in the Accident and Emergency Department who were over 65 years of age and who had sustained a fractured neck of femur. The primary data were collected from January 1999 until February 1999. The comparative data were collected over the same 5-week time period in 2000. The results of the research indicate that since the introduction of the orthopaedic trauma scheme, no patients were admitted within 1 h of arrival in A & E, the Royal College of Physicians recommended target. Only 24% of patients were operated on within the 24-h target set by the Royal College of Physicians. However, the percentage of operations cancelled at least once had fallen. This indicated that the introduction of dedicated trauma lists was effective in ensuring that patients admission to theatre was in a more timely manner.