Improving hand surgery access and care through service redesign

Area of Science:

• Surgical Services
• Trauma Care
• Healthcare Management

Background:

• Major trauma centers often face challenges with emergency hand surgery access.
• Pre-centralization: Poor theatre access led to postponed surgeries, after-hours procedures, and low supervision rates.

Purpose of the Study:

• To evaluate the impact of transitioning to a sequestered, area-wide hand surgery service model.
• To assess changes in processes and patient outcomes following service centralization.

Main Methods:

• A before-and-after study design was employed.
• Data collected over 12 months prior to and 12 months after the implementation of the new service model.
• Analysis focused on key performance indicators including demand, supervision, waiting times, cancellations, and reoperation rates.

Main Results:

• A 24.7% increase in surgical demand was observed post-centralization.
• Specialist supervision rose from 23.5% to 81.3% (P < 0.0001).
• Time from admission to surgery decreased (5.1 to 2.7 h, P < 0.0001), cancellations fell (21.8% to 7.7%, P < 0.0001), and unplanned reoperations decreased (1.2% to 0.5%, P = 0.02).
• Emergency surgeries during normal hours increased significantly (65.8% to 93.6%, P < 0.0001).

Conclusions:

• Centralization of hand surgery services led to improved efficiency and patient outcomes.
• The findings support international experiences with service centralization in surgery.
• This model can serve as a template for practice changes in other surgical specialties.