Impact of orthopedic trauma consolidation on resident education

In July 2005, the Saskatoon Health Region, in conjunction with its orthopedic surgeons, consolidated its management of orthopedic emergencies from 3 sites to 1, resulting in trauma patients being directed to the university hospital site (Royal University Hospital; RUH) where orthopedic residents were the first responders. We sought to measure resident workload in the emergency department, operating room and ward before and after consolidation and to measure the perceptions of residents and faculty on the newly established orthopedic trauma service.

We compared orthopedic volumes at RUH in the emergency department (ED) and trauma-related operating rooms over 2 periods of 3 months' duration before and after trauma consolidation. We developed and disseminated questionnaires evaluating issues relating to patient care; resident education, including all CanMEDS domains; resident well-being; and the orthopedic trauma service to all orthopedic residents and faculty members.

The number of patients seen by orthopedic residents in the ED increased by 67%, the number admitted through the ED to the ward increased by 66%, and the total number of inpatients and consultations increased by 43% after the consolidation. The number of patients processed through the orthopedic emergency operating room increased by 90%. In general, response to the change was positive and appreciated by residents and faculty members.

Sudden substantial increases in the volume of patients seen by orthopedic residents may not prompt negative resident responses when the overall gains offset, if not exceed, the perceived losses.