title: Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital.
abstract: INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate NCEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered.
authors.affiliation: Worcestershire Acute Hospitals NHS Trust , UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Gulamhussein
authors.affiliation: Worcestershire Acute Hospitals NHS Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Chaudhry
authors.affiliation: Walsall Healthcare NHS Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Noor
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust , UK.
authors.forename: T
authors.initials: T
authors.lastname: Chaudhry
authors.affiliation: Worcestershire Acute Hospitals NHS Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Guha
authors.affiliation: Worcestershire Acute Hospitals NHS Trust , UK.
authors.forename: R
authors.initials: R
authors.lastname: Knebel
mesh_terms: D000293:Adolescent; D000328:Adult; D050723:Fractures, Bone / Q000601:surgery; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D009873:Operating Rooms / Q000706:statistics & numerical data*; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D061214:Patient Safety; D013997:Time Factors; D055815:Young Adult
keywords: Life or limb threatening; NCEPOD; Out of hours; Safety; Trauma and orthopaedics