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A Dedicated Orthopaedic Trauma Operating Room Improves Efficiency at a Pediatric Center
Christopher M Brusalis1, Apurva S Shah, Xianqun Luan
11Division of Orthopaedic Surgery (C.M.B., A.S.S., and W.N.S.), Office of Clinical Quality Improvement (X.L.), and Division of Corporate Finance (M.K.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
A dedicated pediatric orthopaedic trauma operating room significantly reduced after-hours procedures and wait times, leading to shorter hospital stays and cost savings. This improved patient flow and outcomes in pediatric trauma care.
Area of Science:
- Orthopaedic Surgery
- Pediatric Trauma Care
- Healthcare Operations Management
Background:
- Dedicated operating rooms enhance efficiency and outcomes in adult orthopaedic trauma care.
- The study investigates the impact of a dedicated orthopaedic trauma operating room at a pediatric level-I trauma center.
Purpose of the Study:
- To determine if a dedicated orthopaedic trauma operating room improves patient flow and reduces costs in a pediatric setting.
- To evaluate the efficiency and safety of a dedicated pediatric orthopaedic trauma operating room.
Main Methods:
- Retrospective analysis of orthopaedic trauma procedures over two 3-year periods (before and after dedicated OR implementation).
- Comparison of efficiency parameters and surgical complications for 5 common pediatric fractures.
- Laparoscopic appendectomies used as a control group to account for external hospital efficiency changes.
Main Results:
- Reduced after-hours procedures by 48% and decreased operating room wait times for specific fractures.
- Shortened mean inpatient hospitalization by 5.6 hours, resulting in a $1,251 cost reduction per patient.
- Observed fewer surgical complications for supracondylar humeral fractures post-implementation.
Conclusions:
- A dedicated pediatric orthopaedic trauma operating room is associated with improved patient flow and cost-effectiveness.
- Implementation led to fewer after-hours cases, reduced wait times, and shorter hospital stays.
- The dedicated OR model shows promise for enhancing pediatric trauma care efficiency and patient outcomes.
Background:
Dedicated orthopaedic trauma operating rooms have improved operating room efficiency, physician schedules, and patient outcomes in adult populations. The purpose of this study was to determine if a dedicated orthopaedic trauma operating room was associated with improved patient flow and cost savings at a level-I pediatric trauma center.
Methods:
A retrospective analysis was performed for two 3-year intervals before and after implementation of a weekday, unbooked operating room reserved for orthopaedic trauma cases. Index procedures for 5 common fractures were investigated, including supracondylar humeral fractures, both bone forearm fractures, lateral condylar fractures, tibial fractures, and femoral fractures. To provide a control group to account for potential extrinsic changes in hospital efficiency, laparoscopic appendectomies were also analyzed. For each procedure, efficiency parameters and surgical complications, defined as unplanned reoperations, were compared between time periods. The mean cost reduction per patient was calculated on the basis of the mean daily cost of an inpatient hospital bed.
Results:
Of 1,469 orthopaedic procedures analyzed, 719 cases occurred before the implementation of the dedicated orthopaedic trauma operating room, and 750 cases were performed after the implementation. The frequency of after-hours procedures (5 P.M. to 7 A.M.) was reduced by 48% (p < 0.001). The mean wait time for the operating room decreased among supracondylar humeral fractures, lateral condylar fractures, and tibial fractures, whereas no significant decrease (p = 0.302) occurred among 2,076 laparoscopic appendectomy cases. The mean duration of the surgical procedure and the mean time in the operating room were not significantly affected. Across all orthopaedic procedures, the mean duration of inpatient hospitalization decreased by 5.6 hours (p < 0.001), but no significant difference occurred among appendectomies. Decreased length of stay resulted in a mean cost reduction of $1,251 per patient. Supracondylar humeral fracture cases performed after implementation of the dedicated orthopaedic trauma operating room had fewer surgical complications (p = 0.018). No difference in complication rate was detected among the other orthopaedic procedures.
Conclusions:
A dedicated orthopaedic trauma operating room in a pediatric trauma center was associated with fewer after-hours procedures, decreased wait time to the surgical procedure, reduced length of hospitalization, and decreased cost.
