Highland Orthopaedic and Trauma (ACCESS)

Optimising use of Trauma and Elective capacity

Piers RenshawRaigmore

Raigmore:• 11 consultants, 8 on call• 5 trainees from Dundee and Aberdeen• 2 SD and 1 GPST • Subspecialities

• Shoulder• Foot and Ankle• Spine• Hands• Paeds• Revision

• Large geographical area with fluctuating population• Large peripheral commitment• @300 hip fractures per annum• @800 arthroplasties per annum• Consume our elective smoke in future ?

Clinicians:• Triaging letters

• 1 consultant 1 session• Urgents to on call surgeon• ‘Only those needing surgical opinion’

• Booking procedures• Ortho administrator• PFB

• Returns by need• Virtual #/Arthroplasty clinics

• Flex IP/OP• In over job plan activity (informed by DCAQ)

• Fill IP/OP avoid DNAs

Beds:• Two wards

• Trauma 30 beds• Elective 28 beds

• LOS• ERAS• Hip fracture nurse

• Minor trauma home while waits• Geography• Pre planning in periphery

• Care elsewhere • Remote non operative care• Repatriation

Theatres: • One all day trauma list (recently converted from split El/Tr)• One half day trauma list Sat and Sun• Two all day Elective lists at present (Longstanding plus Vanguard)• Planned theatre refurbishment includes two Elective theatres plus trauma

theatre• Session usage

• Monthly partners meeting• Start times/surgical briefs• Number of cases• Full day lists• Anaesthetic/surgeon issues• Scheduler !?

Other locations:• Periphery (clinics why not operating)

• Belford, Fort William• Caithness General hospital• Golspie• Broadford, Skye

• Off site but in Inverness• Advantages

• Beds protected• Teams protected• Ring fenced

• Disadvantages• Sick patients• Less flexible if increased trauma load

THANKYOU