Cost analysis of a system of ad hoc theatre sessions for the management of delayed trauma cases.
BACKGROUND
Reducing hospital stay optimizes bed capacity. Shortage of operating time can cause some patients to have their treatment and discharge home delayed. Extra operating sessions could help in reducing such a delay. We performed a feasibility study for a simulated model of trauma lists, implemented ad- hoc to reduce time to surgery.


METHODS
Two hundred thirty-five consecutive trauma admissions were audited. The time required to deliver surgical treatment was recorded. Patients waiting for their operation more than 48 h from admission were allocated into a simulated system of ad hoc trauma lists, using a realistic decision-making process. The potential to reduce time-to-operation was assessed and the number of saved bed occupancy days was calculated. A cost analysis was also performed.


RESULTS
Surgical treatment was delivered within 48 h in 193 (85%) patients, while 32 (15%) patients waited a mean of 3.8 days (3-7), because of insufficient time. To operate on these patients earlier, additional lists would have cost pound38, 703, reducing the time to surgery to 1 day (0-2). This would have saved 86 days of bed occupancy, representing a savings of pound17,200. Restricting the use of extra lists to the elderly patients in the cohort would have required only 11 extra lists and reduced waiting from 3 (3-4) to 1 days (0-2), for a cost of pound22,407. Elderly patients' lists would have had space left to treat additional seven younger patients, with a total saving of 51 bed occupancy days, corresponding to pound10,200.


CONCLUSIONS
The system of ad hoc trauma lists is easy to organize and it appears to impact significantly on patients' discharge and bed capacity. Direct costs to the health service are contained, as they are partially compensated by the improvement in beds availability.
Basso
Oreste
O
Department of Trauma and Orthopaedics, Newham University Hospital, Glen Rd, London, E13 8SL, UK, Oreste.basso@newhamhealth.nhs.uk.