Columbus, OH - March 2016
A number of studies since 2000 have found that surgeries performed outside typical peak staffing times are associated with greater complication rates, which tend to increase length of stay, cost of treatment and mortality. A traditional on-call schedule often has a surgeon handling trauma patients as they present to the emergency department or are admitted, forcing many surgeries into off-peak-staffing hours.
Several members of the Department of Orthopaedics at Nationwide Children’s Hospital have demonstrated in a recent study that on-call models other than the traditional one can result in more than 95 percent of orthopedic trauma surgeries being performed during regular working hours.
“As a level I trauma center, we face challenges efficiently utilizing operating room time during routine hours, competition for operating room time after hours and a finite number of physicians covering call,” says Allan Beebe, MD, lead author of the study and director of Pediatric Orthopedic Trauma at Nationwide Children’s. “We have tried different models to address those challenges and found that more flexible ones work better for us.”
The study, published in Orthopaedic Surgery, retrospectively reviewed three one-year periods with different trauma surgical call schedules. In the year examined with a traditional call schedule, 73 of 177 patients, or 41 percent of those handled Monday-Friday, had procedures begin in the peak-staffing hours of 7 a.m. to 5 p.m.
A second year used a scheduling model reserving an operating room for half-day “trauma block” on week days after a surgeon’s on-call period. That allowed the surgeon to delay procedures, when appropriate, until peak-staffing hours. Of the 214 weekday cases, 206, or 96 percent, had procedures begin during peak staffing hours.
A third year used a scheduling model reserving an operating room for a full-day trauma block on week days after call, again allowing for delayed procedures. Of the 274 weekday cases, 270, or 99 percent, were performed with peak staffing.
Delayed treatment for many common orthopedic cases has been shown to be safe and effective, Dr. Beebe says. Several studies investigating outcomes related to the most common fracture treated with surgery at Nationwide Children’s, supracondylar humerus fracture, have shown no increase in complications with delay.
Additional financial costs associated with after-hours operative treatment and quality-of-life issues for busy pediatric orthopedic surgeons may also need to be considered when deciding on call schedules. Nationwide Children’s has found that a flexible schedule has benefits for the institution and its patients.
“The study supports the continuation of a flexible model for us, and administration, surgeons and nursing staff support it,” Dr. Beebe says.
Beebe AC, Arnott L, Klamar JE, Kean JR, Klingele KE, Samora WP. Utilization of orthopaedic trauma surgical time: an evaluation of three different models at a level I pediatric trauma center. Orthopaedic Surgery. 2015 Nov;7(4):333-7.