This study aims to assess the impact of re-configuration on provision of trauma care at Hospital A, in particular management of hip fractures.

Originally, Hospitals A and B both provided trauma and elective orthopaedic services. These services are undergoing re-configuration such that Hospital A will provide an elective orthopaedic service while Hospital B will provide an orthopaedic trauma service.

Two time periods, one prior to reconfiguration (time period 1) and one after reconfiguration (time period 2) were identified. All trauma patients presenting to Hospital A requiring surgery during the defined time periods were included.

During time period 1, 197 patients requiring surgery presented to Hospital A, 70 with hip fractures. During time period 2, 149 patients requiring surgery presented to Hospital A, 55 with hip fractures.

As part of the reconfiguration process, there was a reduction in dedicated trauma operating capacity at Hospital A with no equivalent increase in operating capacity at Hospital B.

During time period 1, 70% of patients with hip fractures were operated on within 36 hours, compared to 44% during time period 2.

During the re-configuration process, there was a statistically significant decrease in the percentage of patients with hip fractures meeting the recommended standards of care.