Analysis of Ambulatory Trauma in a District General Hospital: System Delays and Need for an Evidence-Based Pathway

Background and aim Ambulatory trauma represents a significant proportion of the orthopedic workload within the UK. Objective delays within ambulatory trauma pathways are poorly documented. This study aimed to quantify delays to surgery and identify modifiable factors to improve ambulatory trauma pathways within a district general hospital. Methods A retrospective analysis was conducted of adult ambulatory trauma patients requiring operative management without admission at a single DGH between September 2023 and January 2024 (n = 72). Overall delay (injury to surgery) and system delay (SD; booking to surgery) were analyzed. Subgroup analyses assessed injury type, subspecialist involvement, booking pathway, and theater setting. Results The mean SD was 4.5 days. Subspecialist involvement was associated with increased delay (4.8 vs 3.3 days, p = 0.02). Patients listed via the fracture clinic experienced longer delays than those booked directly from trauma meetings (7.3 vs 4.4 days, p = 0.18). Surgery on elective lists was associated with longer delays compared with trauma lists (6.2 vs 4.2 days, p = 0.03). Conclusions Ambulatory trauma patients experience significant delays to surgery. Delays were associated with the type of injury, need for subspecialty surgeons, and being listed on an elective list. These findings highlight current service provision deficiencies and the need for streamlined ambulatory trauma care pathways based on objective modifiable factors.