Improving on-call efficiency: impact of the orthopaedic grab-bag in major trauma centres and trauma units.

Abstract

Introduction: Outlier patients - those residing in a ward outside that of the specialty caring for them - often experience delays due to lack of specialty-specific equipment. This study evaluated whether introducing a portable Orthopaedic 'Grab Bag' containing essential equipment improved the efficiency of reviewing and treating Orthopaedic outlier patients in a major trauma centre (MTC) and a trauma unit (TU).

Methods: A prospective study was conducted at both a London MTC and a TU. Equipment retrieval times for common Orthopaedic procedures (including removal of plaster backslabs, removal of staples from a wound, joint aspiration, wound suturing, application of a polysling, skin traction) were measured under two conditions: standard collection versus use of a prepacked Orthopaedic Grab Bag. The primary outcome was total equipment retrieval time.

Results: At the MTC, modal retrieval time decreased from 5-10 minutes to 0-5 minutes post-implementation, with no retrievals exceeding 10 minutes (previously up to 30 minutes). The proportion completed within 5 minutes rose from 21.7% to 64.3%. At the TU, pre-intervention 50% of retrievals were completed within 5 minutes and 15.3% exceeded 10 minutes; post-intervention, all were completed within 5 minutes. The greatest improvements were seen in removal of plaster backslabs (437 seconds faster), polysling application (432 seconds faster) and staple removal from wounds (358 seconds faster).

Conclusions: Implementation of an Orthopaedic Grab Bag improved equipment retrieval efficiency significantly in both MTC and TU settings. This low-cost, scalable intervention enhances the timeliness of Orthopaedic outlier care.