title: Changing the consultant on calls from a daily to weekly rotation system reduces time to theater for patients with hip fracture to improve quality of care: a retrospective study of 2 cohorts of patients presenting with hip fracture.
abstract: OBJECTIVE
  To determine whether changing the consultant on-call schedule resulted in a reduction in time to theater for patients presenting with a hip fracture.
  
  
  BACKGROUND
  Guidelines in the United Kingdom state that patients presenting with a neck of femur fracture should ideally be operated on the day of or the day after admission. However, there is a best practice tariff in the United Kingdom persuading trusts to operate on elderly patients with hip fracture within 36 hours of admission. Differing formats of daily trauma operating lists and varying consultant on-call schedules have the potential to affect a trusts ability to successfully meet such demands.
  
  
  METHODS
  This study retrospectively analyzed whether changing the on-call schedule from a system where the on-call consultant is changed on a daily basis to one which changes weekly resulted in a reduction in time to theater for such patients and an increase in best practice tariffs paid.
  
  
  RESULTS
  With the initial rotation system, the average time to theater for a fractured neck of femur was 44 hours 46 minutes, with 44.7% of patients having a time to surgery of less than 36 hours. Patients in the modified system underwent surgery with an average time to theater of 32 hours 19 minutes. In 71.7% of these patients, time to surgery was less than 36 hours.
  
  
  CONCLUSIONS
  This study demonstrates that changing the schedule to permit a consultant to have a 7-day period of trauma on call at a time instead of only 1 day dramatically reduced the time to theater for patients with hip fracture. This significantly reduced the number of these cases done outside 36 hours and increased trust financial reward.
authors.affiliation: Bedford Hospital NHS Trust, Bedford, United Kingdom.
authors.forename: Maya
authors.initials: M
authors.lastname: Kommer
authors.affiliation: Bedford Hospital NHS Trust, Bedford, United Kingdom.
authors.forename: Kishan
authors.initials: K
authors.lastname: Gokaraju
authors.affiliation: Bedford Hospital NHS Trust, Bedford, United Kingdom.
authors.forename: Sameer
authors.initials: S
authors.lastname: Singh
keywords: basic research; fragility fractures; geriatric trauma; systems of care; trauma surgery