title: Improving hand surgery access and care through service redesign.
abstract: BACKGROUND
  The hand surgery service in our major trauma centre comprised predominantly emergency surgery with poor theatre access, resulting in many cases being postponed and performed after hours and with low rates of supervision.
  
  
  METHODS
  We report the results of a before-and-after study describing the change in processes and outcomes associated with a change in the model of care to a sequestered, area-wide hand surgery service. The study uses data from 12 months prior to and 12 months after the change in practice.
  
  
  RESULTS
  The hand service experienced a 24.7% increase in demand for surgery in the first 12 months after the relocation. However, demand for overnight beds fell by 303%, the rate of specialist supervision increased from 23.5% to 81.3% (P < 0.0001), the time between admission and surgery fell from 5.1 to 2.7 h (P < 0.0001), the rate of cancellations fell from 21.8% to 7.7% (P < 0.0001), the proportion of emergency surgery conducted in normal hours increased from 65.8% to 93.6% (P < 0.0001), the 28-day unplanned reoperation rate fell from 1.2% to 0.5% (P = 0.02) and surgical time decreased to an equivalent of 41 half day operating sessions per year.
  
  
  CONCLUSIONS
  These outcomes are in line with international experiences of service centralization. The project may be used as a template for practice change in other surgical fields.
authors.affiliation: Critical Care & Surgical Specialties Clinical Stream, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Isedale
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Harris
authors.affiliation: South Western Sydney Hand Centre, Fairfield Hospital, Prairiewood, New South Wales, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Rider
mesh_terms: D017598:Efficiency, Organizational / Q000639:trends*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D009517:New South Wales; D009873:Operating Rooms / Q000458:organization & administration*; D019637:Orthopedic Procedures / Q000592:standards*; D014194:Traumatology / Q000639:trends*
keywords: hand; organizational models; surgery