The effect of the creation of a ring-fenced orthopaedic ward on length of stay for elective arthroplasty patients.
BACKGROUND
More than 150,000 hip and knee joint replacements are carried out in the United Kingdom yearly, and variations in length of stay [LOS] affects the overall costs of the procedures. This audit assesses the effect of the introduction of specialist ward on LOS following arthroplasty.


METHODS
A combination of prospective and retrospective data on length of stay, demographics, and surgical site infections [SSI] were collected for the six months before and six months after the specialist ward was opened. Primary lower limb arthroplasty data was evaluated. American Society of Anaesthesiologists Physical Status Scores [ASA] for all admissions for lower limb arthroplasty were compared.


RESULTS
Mean LOS for 222 patients managed in general orthopaedic wards was 7.61 days compared to 5.67 days for 191 patients managed in a dedicated arthroplasty ward. Three surgical site infections [SSIs] were noted in the general ward compared to zero in the specialist ward.


CONCLUSIONS
This audit demonstrates a two-day reduction in LOS for patients managed in a ring-fenced ward. The cause of the reduction is multifactorial and not solely due to a trend for reduced SSI but influenced by many other changes cascading from the original organisational revision. Overall reduced stay however can only increase efficiency if downstream resources are available. Other units may wish to explore the benefits from similar dedicated wards in response to a growing demand for arthroplasty within a system of fixed resources.
Department of Orthopaedics, Ysbyty Gwynedd, Bangor LL57 2PW, UK. daveybarlow@hotmail.com
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D
Barlow
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S
Masud
S J
SJ
Rhee
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M
Ganapathi
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G
Andrews
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D017558:Elective Surgical Procedures; D006757:Hospital Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D012189:Retrospective Studies