Abstract
With increased shift working, multiple hand-overs, demand for trauma beds frequently outstripping supply, split-site working, shared care with other specialties and tertiary referrals awaiting transfer, keeping track of trauma patients can be difficult. To solve this problem we developed the Virtual Trauma Orthopaedic Management System (VTOMS) to monitor pre-operative trauma inpatients. VTOMS is a secure, networked system linked to the patient administration system (PAS). It can be accessed by the entire multidisciplinary team from any PC in the Trust. The main information is also displayed on plasma screens in the trauma unit.
The status of patients requiring surgery is displayed (e.g. fit and ready, awaiting investigation, or unfit) with alerts on acutely unwell or unstable patients. Further details can be obtained by ‘drilling down’. The system has an inbuilt patient clock which ‘traffic lights’ patients awaiting theatre, providing a visual warning if waiting time is prolonged. Amber is set at 48 hours and red is 72 hours for most injuries. This facilitates real-time management of the trauma workload, allowing extra resources to be deployed early if it is seen that waiting times are climbing, or the case-mix is particularly complex.
After successful use on trauma inpatients, the VTOMS system was extended to create a ‘virtual trauma ward’ where patients are pre-assessed in hospital and, if clinically appropriate, wait at home until a suitable theatre slot becomes available. The patient is contacted daily to monitor their clinical situation and brought in fasting on the morning of surgery. Using this ‘just in time’ philosophy 195 patients passed through our ‘virtual trauma ward’ in the six months to December 2009. The reduced length of stay saved 514 bed days, equivalent to £115,650 (£231,300 per annum), and minimised the impact of trauma on the elective service.
