Improving patient flow: the impact of consultant work pattern on trauma ward efficiency

Abstract

Objective: To determine the effect on trauma ward efficiency of altering consultant shift patterns.

Design: Outcome measures were compared for neck of femur fracture patients before and after the consultant rota changed (Feb 2007) from a single day on-call to a full week on-call.

Setting: Patients admitted to Stirling Royal Infirmary with neck of femur fractures.

Participants: 359 patients were identified from the Scottish Hip Fracture Audit database for the year preceding the rota change and 379 after.

Main outcome measures: Time to surgery for medically fit patients and overall length of stay on the acute trauma ward.

Results: Patients were operated on quicker after the rota change (Mann-Whitney U-test, before v after: z=2.67, p=0.008), with a greater percentage being operated within the first 24h (60% before v 78% after; Chi-square test, before v after: χ(1)(2)=19.9, p<0.001). Overall, the length of stay on the acute trauma ward was reduced (Chi-square test, before v after by intervals: χ(3)(2)=21.1, p<0.001). The proportion of patients discharged from the ward within one week increased from 47% before the rota change to 63% after.

Conclusion: By applying the industry-based methods of 'process management', we have shown that a simple intervention (alteration of consultant shift patterns) has had a significant impact in reducing time to theatre for neck of femur trauma patients and reducing the length of stay on the acute trauma ward. Thus, the 'patient flow' has been made more efficient making more acute trauma beds available for new admissions.