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Trend of 7-day full service in hospitals has started to affect orthopaedic surgeons
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The government in the United Kingdom has announced that, starting in 2020, 7 days of full service shall be implemented for general practices, as well as hospitals that handle emergency cases and other patients with a need for urgent care. In the Cover Story in this issue of Orthopaedics Today Europe, there is a lengthy discussion of the U.K. decision related to this type of service and it includes comments from orthopaedic surgeons in the United Kingdom, as well as other countries.
One reason for the decision by the health service in United Kingdom is related to a 2012 publication in which an analysis showed patients admitted to hospitals on Saturday or Sunday had a significantly higher mortality rate than patients admitted on Wednesdays, for example.
I am sure all health care providers want to treat their patients at the same high level of care during the entire week, but several factors, which include national working regulations, periodical lack of qualified specialists and geographical challenges, may influence and possibly hinder their ability to deliver such care. Reasons like these may actually render the goal of a 7–day full service, like the one mandated in the United Kingdom, nearly impossible to attain.
Orthopaedists: Part of the solution
We, as orthopaedic surgeons, already are doing well with regard to the aspects of 7-day full service. In most European nations, orthopaedic surgeons are the ones who are part of the team that receives acute trauma patients 24/7, as well as members of the team that acutely treat lesions of the musculoskeletal system 24/7. Trauma units have been set up based on detailed trauma manuals that describe stratified treatment, so I would be surprised if an analysis of patients treated in those units across Europe today showed any differences in mortality similar to those patients reported on in the 2012 study.” There may be other areas within our orthopaedic organizations that need to be more closely analyzed or possibly re-organized so care can be better delivered 24/7.
It is now a general trend that hospitals reduce most of their services on Saturdays and Sundays, so the main patient flow occurs Monday through Friday. This may result in a sudden increase in acute cases that present on the weekend and could affect the ability of the on-duty staff to effectively run the acute care program on weekends.
From our duties related to the treatment of acute orthopaedic patients, we have experienced waiting for diagnostic results and subsequent delays in surgery. In those cases, it was likely we were unable to proceed with surgery due to the staff in other specialties competing with us for the anesthesia team, resources and surgical rooms. Frequently, orthopaedic patients will lose this kind of “competition” to patients who have acute abdominal conditions, vascular lesions or who must undergo unscheduled caesarean section or other more urgent surgeries.
Take political action
The orthopaedic community needs to discuss how to overcome these obstacles. We should actively initiate debates on this topic with both local and national politicians.
Here is one problem that should be resolved. In areas of Europe, such as my own — Denmark — larger trauma centers have been established and lesser clinics that once handled acute care have been closed. This makes sense, since minor clinics frequently had problems due to staffing by specialists who are not trained to handle specialized trauma cases. Also, the general service the minor clinics provided on the weekend was often minimal.
However, a problem also exists when a larger clinic receives a significantly higher than expected number of acute cases. This situation may impact a patient’s outcome at any given time, as the highly trained specialists can only treat so many patients.
Orthopaedic surgeons are already there the majority of the time with full services 24/7, but we must debate the increased burden that large trauma units face. These units now provide acute services to a greater number of patients in a larger geographic area than ever before. We should be the ones to spearhead such a discussion, as its outcome directly affects the safety of our patients.
- Reference:
- Freemantle N, et al. J R Soc Med. 2012;doi:10.1258/jrsm.2012.120009.
- For more information:
- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Rd., Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.