O0807 Oct.3: 2:02pm - Effectiveness of an Early Operating Room Start Time in Managing Pediatric Supracondylar Humerus and Femoral Shaft Fractures

Background/Purpose
Pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) commonly require non-emergent operative treatment. Expeditious treatment of these injuries is used as a marker for the quality of a hospital system. Given the incidence of these injuries, the U.S. News and World Report has chosen the timing of their management as a measure of hospital efficiency in managing trauma. A delay of more than 18 hours from admission to surgery negatively affects a hospital’s rank. Here, we describe the effect of a program allowing an early operating room start for uncomplicated trauma prior to an elective day. The goal of this program was to decrease wait times for surgery for non-emergent fractures admitted overnight.

Methods
Starting in October 2017, we implemented a program at a suburban academic Level I trauma center allowing on call surgeons to book an uncomplicated SCHF or FSF case in an early time slot if the patient was admitted to the emergency department after 21:00 and before 05:00. Using CPT and ICD-9 codes, we performed a retrospective review of pediatric closed SCHF and FSF without concern for vascular injury treated one year before and after program implementation. We compared demographics and timing of treatment. For opinion analysis, an anonymous feedback survey was disseminated to medical personnel involved in the program.

Results
Of 61 SCHF meeting inclusion criteria, 24 received operative treatment before implementation and 37 after. No differences in age, sex, or Gartland type were noted between groups. Of 9 FSF meeting inclusion criteria, 5 received operative treatment before implementation and 4 after. Upon implementation, mean wait time for surgery decreased by 30.5% (14.1 hrs vs. 9.8 hrs; P<0.001) for SCHF and 31.6% (13.9 hrs vs. 10.3 hrs; P=0.032) for FSH. The percentage of patients with less than 18 hour delay from admission to surgery increased after implementation from 79% to 100% (P=0.004) for SCHF and from 60% to 100% (P=0.444) for FSF. There were no significant differences in operative duration, wait time in the PACU, and wait time for discharge before and after implementation for either fracture type. Whereas 57% of orthopaedic surgeons responding to the survey believed that the program was an effective management technique, only 16% of nurses and 9% of anesthesiologists agreed (P=0.009).

Conclusion
The program reduced wait times for surgery for uncomplicated SCHF and FSF presenting overnight. The program was ultimately discontinued at our institution given dissatisfaction among anesthesia and nursing staff primarily because it involved calling them in from home during the final hour of their shifts. These results can assist other institutions in successfully implementing quality improvement programs encouraging efficient management of SCHF and FSF.