931 Minimising Surgical Inpatient Bed Use and Maximising Patient Flow in Plastic Surgery: Proposal for Combined Acute Trauma Clinic with Attached Local Anaesthetic Theatre and Ambulatory Care with IV Therapy ServiceA Jawad, M Kadhum
The majority of hand trauma referrals to plastic surgery consist of minor injuries that ideally require initial washout and exploration under local anaesthetic, during which repair of most damaged structures can also be undertaken. Meanwhile, a significant proportion of acute admissions to plastic surgery are for infected wounds requiring washout, intravenous antibiotics, limb elevation, and daily wound review to ensure resolution. These occupy surgical beds of often-limited capacity, and confine otherwise generally mobile, independent patients.
Trauma clinics are well-established, often being utilised as see-and-treat services (Rea-et-al 2004), reducing the wait for a potentially unpredictable main trauma theatre, with proven cost benefit (Cullen-et-al 2021). This is further aided by patient counselling regarding waiting times for surgery (Khan & Iqbal 2021), and the model has been augmented to incorporate virtual reviews (Westley-et-al 2020). Infected wounds amenable to local anaesthetic or wide-awake-local-anaesthetic-no-tourniquet (Lalonde 2015) could similarly be managed in this environment, but may necessitate admission for intravenous antibiotics, nevertheless. However, soft-tissue infections are increasingly being managed in outpatient settings through using single/twice-daily dosed antibiotics with daily review (Ektare et al 2015).
An ideal configuration would therefore consist of a trauma clinic space with assessment bays, local anaesthetic minor theatre, and IV infusion chair(s), staffed by a receptionist, an assessing doctor/nurse practitioner, an operating surgeon with scrub nurse/trained healthcare assistant, and an IV-trained nurse.
We believe that this cost-effective setup would ensure patients receive timely adequate care for acute limb trauma and infections while reducing inpatient presence and improving efficiency.