Improving on-call efficiency: impact of the orthopaedic grab-bag in major trauma centres and trauma units

Outlier patients - those residing in a ward outside that of the specialty caring for them - often experience delays due to lack of specialty-specific equipment. This study evaluated whether introducing a portable Orthopaedic 'Grab Bag' containing essential equipment improved the efficiency of reviewing and treating Orthopaedic outlier patients in a major trauma centre (MTC) and a trauma unit (TU).

A prospective study was conducted at both a London MTC and a TU. Equipment retrieval times for common Orthopaedic procedures (including removal of plaster backslabs, removal of staples from a wound, joint aspiration, wound suturing, application of a polysling, skin traction) were measured under two conditions: standard collection versus use of a prepacked Orthopaedic Grab Bag. The primary outcome was total equipment retrieval time.

At the MTC, modal retrieval time decreased from 5-10 minutes to 0-5 minutes post-implementation, with no retrievals exceeding 10 minutes (previously up to 30 minutes). The proportion completed within 5 minutes rose from 21.7% to 64.3%. At the TU, pre-intervention 50% of retrievals were completed within 5 minutes and 15.3% exceeded 10 minutes; post-intervention, all were completed within 5 minutes. The greatest improvements were seen in removal of plaster backslabs (437 seconds faster), polysling application (432 seconds faster) and staple removal from wounds (358 seconds faster).

Implementation of an Orthopaedic Grab Bag improved equipment retrieval efficiency significantly in both MTC and TU settings. This low-cost, scalable intervention enhances the timeliness of Orthopaedic outlier care.