Following my appointment in May 2006, a major objective was to help improve the management of lower limb trauma patients. These patients, many of whom are elderly often wait for weeks at their local hospitals before transfer to the QVH for surgery.
I took on the role of surgical lead for the newly convened Outliers’ Committee chaired by Tony Josling and including representatives from anaesthetics, admissions, the wards and management. The aim was to i) improve the triaging of referrals, ii) minimise inappropriate transfers of unfit patients, iii) shorten the referral to surgery time, and iv) expedite repatriation to the referring hospital.
I have re-drafted the Outlier Referral Form to capture as much relevant information as practical and thus aid triage. I have also instituted a system requiring that all referrals are discussed with me or a colleague with a lower limb trauma interest prior to formal acceptance. Finally, with the help of management, specified operating lists were identified for outliers to minimise cancelled operations.
A recent re-audit revealed shorter intervals from referral to admission and from admission to surgery, fewer cancelled operations, shorter hospital stay, and zero peri-operative deaths.
Further improvement by speedier repatriation to the local hospital is an area for further improvement.
