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Day Case Orthopaedic Trauma – BADS Conference
Conference Summary Report
Chaired by Ms Sarah Stapley, Consultant in Trauma and Orthopaedics, Portsmouth Hospitals University NHS Trust, this conference focused on day case orthopaedic trauma surgery, with presentations from leading experts in the field highlighting the benefits of day case surgery, including reduced hospital stays, improved patient outcomes, and increased efficiency in hospital resources.
Advancing Day Case Orthopaedic Surgery
Professor Bob Handley, Clinical Lead for GIRFT Orthopaedic Trauma and Consultant Orthopaedic Surgeon at Oxford University Hospitals NHS Foundation Trust, discussed the evolution of orthopaedic trauma care and the importance of day case surgery. He highlighted the challenges in decision-making, bed availability, and patient pathways, emphasizing the need for early decisions and proper day case facilities. Bob also mentioned a study that identified potential day case trauma patients and the lack of routine data collection for such cases. He concluded by advocating for a structured pathway for held-at-home patients and the implementation of day case surgery where appropriate.
Day Surgery Pathway Implementation
Dr Pallavi Dasannacharya, Honorary Secretary of BADS and Clinical Lead Day Surgery Unity, St George’s University Hospitals NHS Foundation Trust, presented on the key elements of a day surgery pathway, focusing on ambulatory trauma surgery. She highlighted the benefits of day surgery, including patient preference for home recovery, reduced infection risk, and financial advantages for hospitals. Pallavi emphasized the importance of standardizing, streamlining, and supporting the day surgery process, as well as having dedicated facilities and staff skilled in day-case procedures. She discussed patient suitability criteria for day surgery, including the ability to manage pain and mobility postoperatively, and encouraged hospitals to review their current practices and data to identify opportunities for implementing day surgery pathways.
Day Case Hand Surgery Pathway
Dr. Kim Russon and Mr. Tim Halsey from Rotherham NHS Foundation Trust shared their experience in managing hand and wrist trauma surgery as a day case procedure. They explained the development of their pathway, which includes preoperative assessment by trauma coordinators, the use of regional anaesthesia, and postoperative care. The team has found that regional anaesthesia, including nerve blocks, can be effective for many hand surgeries, allowing patients to avoid general anaesthesia and recover more quickly. They also discussed the role of trauma coordinators in patient advocacy and the importance of clear communication between surgeons, anaesthetists, and patients.
Hand Surgery and Patient Care: Wide-awake local anaesthetic no tourniquet
Tim discussed hand and wrist surgery, focusing on day surgery hand trauma lists and the technique of wide-awake local anaesthetic no tourniquet (WALANT) surgery. He explained the benefits and contraindications of WALANT, as well as the importance of patient selection and proper injection techniques. Tim also covered the use of wrist blocks for post-operative analgesia and emphasized the need for good communication with patients about recovery expectations. Kim provided information on patient questionnaires and follow-up procedures, noting a 70% response rate to text message surveys. The discussion concluded with a brief overview of pre-operative assessment requirements for day case surgery patients.
Day Case Trauma Centres Development
Sabina Barbur, Consultant in Trauma and Orthopaedics, Royal Devon University Healthcare NHS Foundation Trust, presented on establishing day case trauma centres, highlighting the need for a business plan due to increasing MSK trauma cases and decreased patient and staff satisfaction since COVID. She emphasized creating new pathways to reduce burnout and improve efficiency, noting that trusts should identify problems locally, assess capacity issues, and consider financial implications. Sabina also discussed the importance of staff engagement, appropriate facilities, and having an escalation pathway, while suggesting that trusts need dedicated trauma pathways by 2030.
Day Surgery Trauma Pathway Success
Sarah Stapley, Consultant in Trauma and Orthopaedics, and her team from Portsmouth Hospitals NHS Trust presented their successful day surgery trauma pathway, which has reduced inpatient stays and improved patient outcomes. The pathway was developed in response to bed capacity issues and increasing trauma volumes, with early intervention and appropriate patient selection key components. Dr Shirley Lobo, Consultant & Day Surgery Liaison Anaesthetist, discussed anaesthetic techniques and patient selection criteria, while Anne Del Rosario, Staff Nurse in Day Surgery, explained the day surgery unit's role in managing trauma patients. Claire Kennedy, Ward Manager and Co-Lead for Orthopaedic Day Case Pathway Development, shared the "big room" concept used to develop the pathway, emphasizing collaboration and continuous improvement. The financial benefits of day surgery were highlighted by Sarah, with significant cost savings achievable through reduced inpatient stays.
Obstructive Sleep Apnoea Management in Surgical Pathway
The team discussed progress in managing patients with obstructive sleep apnoea (OSA) in the surgical pathway. Sarah explained that patients compliant with CPAP can now undergo day surgery with a low opioid technique, while those with untreated moderate or severe OSA are rarely considered for day surgery. The team has implemented a watch pad system for OSA screening, which is funded by the NHS and allows for expedited CPAP trials. They also discussed the management of non-weight-bearing patients with ankle fractures, noting that those unable to use crutches or a Zima frame must be admitted for treatment.
Trauma Care Coordination Strategies
Lisa Woods Trauma Nurse Coordinator at Portsmouth Hospitals University NHS Trust, described her role in coordinating trauma care, including organizing trauma lists, managing patient transfers, and liaising with surgeons and theatres. She highlighted the development of a trauma assessment unit and the expansion of nurse-led care, emphasizing the importance of clear communication and patient education. Agnieszka Hawkins, T&O Trauma Coordinator, Buckinghamshire Healthcare NHS Trust, outlined her role in managing the day surgery pathway, including patient education, medication management, and expectation setting. Both speakers discussed challenges such as cancellations, staff shortages, and patient compliance, while emphasizing the benefits of collaborative decision-making and efficient patient pathways.
Day-Case Orthopaedic Surgery Challenges
The meeting focused on the current state and challenges of day-case surgery, particularly in orthopaedic trauma, across the UK. Mr Will Eardley, Consultant Orthopaedic Trauma and Limb Reconstruction Surgeon, South Tees Hospitals NHS Trust presented findings from the Orthopod study, highlighting that while about a third of orthopaedic trauma cases could be suitable for day-case procedures, only 5% are currently being treated this way. He emphasized the need for better hospital networking and resource allocation to improve day-case surgery rates. The discussion also touched on the increasing demand for orthoapedic procedures due to an aging population, predicting a significant rise in hip fractures by 2029. Will encouraged attendees to use the study's data to advocate for day-case surgery improvements, noting its potential to free up hospital beds for other urgent care needs.
Ambulatory Trauma Pathway Success
Mr Robert W Jordan, Consultant Shoulder & Elbow Surgeon, Ambulatory Trauma Lead, University Hospitals Birmingham NHS Foundation Trust presented on the ambulatory trauma pathway, describing how they have successfully implemented day case surgery for over 100 trauma patients monthly. The service has reduced mean length of stay from 1.8 days pre-COVID to 0.27 days post-COVID, saving approximately 1,600 bed days annually. Key improvements included having dedicated trauma nurse practitioners, clear pathways for different types of fractures, and coordination with various hospital departments. The service has maintained good patient satisfaction rates despite challenges with managing ankle fractures and limited physiotherapy availability.
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