title: Management of hip fractures pre- and post-Major Trauma Centre activation.
abstract: BACKGROUND
  In April 2012, the activation of the regional trauma networks in England was carried out to improve the organisation of trauma care. NHS Trusts that could meet the highest standard of care to complex trauma were designated Major Trauma Centres (MTCs). MTCs receive patients fulfilling certain triage criteria, as well as secondary transfers from nearby trauma units. While complex trauma care is streamlined with this new organisation, the impact this would have on the rest of the trauma workload within MTCs as well as non-MTC hospitals is uncertain. We investigate whether the management of hip fracture cases had suffered as a result of a trauma unit becoming a MTC.
  
  
  METHODS
  Summary data was collated from the National Hip Fracture Database website for the periods of April 2011-April 2012 (the 'pre-MTC' activation period) and April 2012-April 2013 (the 'post-MTC' activation period). As our primary outcome, we compared the time to surgery within 36h between MTCs and non-MTCs for the periods detailed above. Other outcome measures were: reasons for delay to surgery, length of acute stay, proportion of cases meeting Best Practice Tariff criteria.
  
  
  RESULTS
  A total of 54,897 and 55,998 fNOF patients were included for all hospitals in England in the pre- and post-MTC periods respectively. For MTCs, a weighted mean average of 66.6% patients had surgery within 36h in the pre-MTC period versus 71.4% of patients in the post MTC period (p<0.0001). For non-MTCs, a weighted mean average of 70.0% of patients had surgery within 36h in the pre-MTC period versus 73.8% of patients in the post-MTC period (p<0.0001). Non-MTCs in both pre- and post-MTC activation periods were therefore better in percentage of patients receiving surgery within 36h.
  
  
  CONCLUSIONS
  The data presented suggests that the creation of MTCs has not had a deleterious effect on the management of hip fracture patients. This paper aims to stimulate the important discussion of maintaining a consistently improving standard throughout the spectrum of trauma care, in conjunction with the development of regional Major Trauma Networks.
authors.affiliation: Orthopaedic Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom. Electronic address: ken.wong@doctors.org.uk.
authors.forename: Ken
authors.initials: K
authors.lastname: Wong
authors.affiliation: Cambridge University Medical School, University of Cambridge, United Kingdom. Electronic address: jr519@cam.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Rich
authors.affiliation: Orthopaedic Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom. Electronic address: gcky2111@gmail.com.
authors.forename: Grace
authors.initials: G
authors.lastname: Yip
authors.affiliation: Orthopaedic Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom. Electronic address: con.loizou@doctors.org.uk.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Loizou
authors.affiliation: Orthopaedic Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom. Electronic address: peter.hull@addenbrookes.nhs.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Hull
mesh_terms: D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D005260:Female; D018166:Health Care Reform; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data* / Q000639:trends; D011787:Quality of Health Care / Q000458:organization & administration* / Q000639:trends; D012189:Retrospective Studies; D013222:State Medicine / Q000458:organization & administration* / Q000639:trends; D061665:Time-to-Treatment / Q000706:statistics & numerical data* / Q000639:trends; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards; D016896:Treatment Outcome
keywords: Best practice tariff; Delay to surgery; Fracture neck of femur; Fragility fractures; Hip fractures; Major Trauma Centre; NOF; National Hip Fracture Database; Proximal femur fracture; Trauma network