Increasing operating room capacity through a dedicated Satellite Trauma Orthopedic Program

Improving patient safety is a constant endeavor for all caregivers, and relies greatly on effective and timely treatment. For orthopedic surgery cases, this means avoiding delays in surgical intervention, while limiting surgical complications and ensuring patients receive the correct level of care. Operating room (OR) and surgery capacity are limited, vital resources that need careful management. With these goals in mind, Boston Children’s Orthopedics and Sports Medicine Center implemented an innovative program utilizing the OR capacity of a satellite campus in order to decrease stress on our pediatric tertiary care center’s operating rooms, while keeping the focus on patient safety.

This is the first study to report using a tertiary care hospital’s satellite facility operating rooms for additional, less complex orthopedic trauma patients. It was based around a triage and transfer system that allowed more serious orthopedic trauma cases to receive care at the main hospital location, while simultaneously opening up OR allocation and inpatient beds to other surgical subspecialty urgent and less emergent cases. Families were given the option to opt out of a patient transfer, and ambulance transportation was offered to the family at no extra cost.

From June 1, 2016 through June 30, 2017, 480 cases (372 trauma, 108 elective) were completed in our satellite OR. There were no technical or clinical intraoperative complications as a result of surgical or anesthesia care at the satellite location, no episodes of compartment syndrome and no patients required transfer back to our tertiary care facility for unexpected or serious medical issues.

The success of this program is due in large part to the Delphi method used to develop and implement orthopedic, emergency department and anesthesia screening criteria to determine eligibility for the surgical management of orthopedic trauma patients at the satellite location. Under similar procedures and protocols, other institutions with high trauma volume, limited OR capacity and an available satellite or multiple OR locations could potentially benefit from this type of program.

 

Waters PM, Yang BW, White D, Barth E, Chiang V, Mizrahi-Arnaud A, Sparks W. A Dedicated Satellite Trauma Orthopaedic Program Operating Room Safely Increases Capacity. J Bone Joint Surg Am. 2018 May 16;100(10):e70.
https://www.ncbi.nlm.nih.gov/pubmed/29762292