title: Improving patient flow: the impact of consultant work pattern on trauma ward efficiency.
abstract: OBJECTIVE
  To determine the effect on trauma ward efficiency of altering consultant shift patterns.
  
  
  METHODS
  Outcome measures were compared for neck of femur fracture patients before and after the consultant rota changed (Feb 2007) from a single day on-call to a full week on-call.
  
  
  METHODS
  Patients admitted to Stirling Royal Infirmary with neck of femur fractures.
  
  
  METHODS
  359 patients were identified from the Scottish Hip Fracture Audit database for the year preceding the rota change and 379 after.
  
  
  METHODS
  Time to surgery for medically fit patients and overall length of stay on the acute trauma ward.
  
  
  RESULTS
  Patients were operated on quicker after the rota change (Mann-Whitney U-test, before v after: z=2.67, p=0.008), with a greater percentage being operated within the first 24h (60% before v 78% after; Chi-square test, before v after: χ(1)(2)=19.9, p<0.001). Overall, the length of stay on the acute trauma ward was reduced (Chi-square test, before v after by intervals: χ(3)(2)=21.1, p<0.001). The proportion of patients discharged from the ward within one week increased from 47% before the rota change to 63% after.
  
  
  CONCLUSIONS
  By applying the industry-based methods of 'process management', we have shown that a simple intervention (alteration of consultant shift patterns) has had a significant impact in reducing time to theatre for neck of femur trauma patients and reducing the length of stay on the acute trauma ward. Thus, the 'patient flow' has been made more efficient making more acute trauma beds available for new admissions.
authors.affiliation: Stirling Royal Infirmary, Livilands Gate, Stirling FK8 2AU, UK. hiren.divecha@doctors.org.uk
authors.forename: Hiren M
authors.initials: HM
authors.lastname: Divecha
authors.forename: Rik D
authors.initials: RD
authors.lastname: Smith
authors.forename: Chirs
authors.initials: C
authors.lastname: Cairns
authors.forename: Jens
authors.initials: J
authors.lastname: Bayer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003253:Consultants; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000601:surgery*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010351:Patient Discharge / Q000639:trends*; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D013997:Time Factors