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Is it Financially Efficient to Lose the Ring-Fenced Elective Orthopaedic Ward?

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Abstract

Background

In an effort to rationalize National Health Service (NHS) funds in the United Kingdom, some hospitals have used the orthopaedic elective ring-fenced ward to admit general acute emergencies, admitting elective arthroplasty patients to general wards.

Objective

The aim of this study was to analyse the financial effect and length of stay of elective arthroplasty patients admitted to general wards rather than ‘ring-fenced’ orthopaedic wards.

Study Design

Retrospective observational study

Setting

Hospital care

Patients

During the period between 01 November 2010 and 31 March 2011, 194 consecutive patients were admitted for elective total hip and total knee arthroplasties. Due to increased bed pressures, 35 (18.04 %) of the patients were admitted to general wards instead of our standard elective ring-fenced orthopaedic ward. Data was collected and analysed for type of surgery, age, sex, length of stay, and ward.

Results

The average length of stay in the general wards was 1.89 days longer (range 3–22 days; p < 0.001) than in the elective orthopaedic ward.

Conclusions

We conclude that losing the ring-fenced ward and admitting elective arthroplasty patients to general wards results in longer length of stay and a financial loss of 6.82 % per hip and knee arthroplasty patient.

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References

  1. National Joint Registry of England and Wales, 8th annual report, Hemel Hempstead: The NJR Centre, 2011.

  2. Wainwright T, Middleton R. An orthopaedic enhanced recovery pathway. Curr Anaesth Crit Care. 2010;21(3):114–20.

    Article  Google Scholar 

  3. Briggs TWR. Getting it right the first time: improving the quality of orthopaedic care within the National Health Service in England (online). http://www.timbriggs-gettingitrightfirsttime.com/report/. Accessed 26 Feb 2013.

  4. Biant LC, Teare EL, Williams WW, Tuite JD. Eradication of methicillin resistant Staphylococcus aureus by “ring fencing” of elective orthopaedic beds. BMJ. 2004;329:149–51.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Barlow D, Masud S, Rhee S, Ganapathi M, Andrew G. The effect of a ‘ring-fenced’ orthopaedic arthroplasty ward on length of stay and surgical site infection (abstract). J Bone Joint Surg. 2011;93B(Suppl. 2):159.

    Google Scholar 

  6. Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthopaedica. 2008;79(2):168–73.

    Article  PubMed  Google Scholar 

  7. Hommel A, Bjorkelund K, Thorngren K, Ulander K. Differences in complications and length of stay between patients with a hip fracture treated at an orthopaedic department and patients treated at other hospital departments (abstract). J Bone Joint Surg. 2010;92B(Suppl. 2):300–1.

    Google Scholar 

  8. Department of Health. White paper on equity and excellence: liberating the NHS. London: United Kingdom Department of Health; 2010.

    Google Scholar 

  9. Department of Health. The NHS quality innovation, productivity and prevention challenge: an introduction for clinicians. London: United Kingdom Department of Health; 2010.

    Google Scholar 

  10. Gomez KF, Bradbury-Willis SA, Cox AC, Ahmed H, Mansel RE, Goyal S. Effect of ring-fencing of surgical beds on delivery of breast surgical services in the United Kingdom (poster presentation). In: Proceedings of the breast cancer symposium; 7–8 Sep 2007; San Francisco (CA).

  11. Snowden CP, Anderson H. Preoperative optimization: rationale and process: is it economic sense? Curr Opin Anaesthesiol. 2012;25(2):210–6.

    Article  PubMed  Google Scholar 

  12. Munton T, Martin A, Marrero I, Llewellyn A, Gibson K, Gomersall A. Evidence: getting out of hospital? The evidence for shifting acute inpatient and day case services from hospitals into the community. London: The Health Foundation, 2011 http://www.health.org.uk/publications/getting-out-of-hospital/.

  13. Matheï C, Niclaes L, Suetens C, Jansb B, Buntinx F. Infections in residents of nursing homes. Infect Dis Clin N Am. 2007;21:761–72.

    Article  Google Scholar 

  14. Barr B, Wilcox MH, Brady A, et al. Prevalence of methicillin-resistant Staphylococcus aureus colonization among older residents of care homes in the United Kingdom. Infect Control Hosp Epidemiol. 2007;28(853):e9.

    Google Scholar 

  15. Baldwin NS, Gilpin DF, Hughes CM, et al. Prevalence of methicillin-resistant Staphylococcus aureus colonization in residents and staff in nursing homes in Northern Ireland. J Am Geriatr Soc. 2009;57(620):e6.

    Google Scholar 

  16. Eveillard M, Charru P, Rufat P, et al. Methicillin-resistant Staphylococcus aureus carriage in a long-term care facility: hypothesis about selection and transmission. Age Ageing. 2008;37(294):e9.

    Google Scholar 

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Acknowledgments

No sources of funding were used to conduct this study. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Trauma and Orthopaedics, Luton & Dunstable Hospital, NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK

    J. Agustin Soler, Sanjiv Manjure & Yegappan Kalairajah

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  1. J. Agustin Soler
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  2. Sanjiv Manjure
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  3. Yegappan Kalairajah
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Correspondence to J. Agustin Soler.

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Soler, J.A., Manjure, S. & Kalairajah, Y. Is it Financially Efficient to Lose the Ring-Fenced Elective Orthopaedic Ward?. Appl Health Econ Health Policy 11, 151–154 (2013). https://doi.org/10.1007/s40258-013-0018-0

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  • DOI: https://doi.org/10.1007/s40258-013-0018-0

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