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Improving hand surgery access and care through service redesign.

Grant Isedale¹, Ian Harris², Mark Rider³

¹Critical Care & Surgical Specialties Clinical Stream, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.

ANZ Journal of Surgery

|December 4, 2015

Summary

Centralizing hand surgery services significantly improved care by increasing supervision and reducing delays and cancellations. This model enhanced efficiency and patient outcomes, aligning with international trends in surgical centralization.

Keywords:

hand organizational models surgery

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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.