Orthopaedic surgical treatment waiting time for acute musculoskeletal trauma patients attended at Muhimbili Orthopaedic Institute

Abstract

ABSTRACT Waiting time for acute musculoskeletal trauma surgery has been used as a measure of institutional efficiency. Delay in operating on trauma patients leads to increased morbidity, mortality and reports have shown negative impacts and additional costs for the hospitals besides inconvenience to patients and their families. Objectives: To determine the extent and causes of delay of orthopaedic surgical treatment among acute musculoskeletal Trauma patients attended at MOI from July 2018 to February 2019. Methodology: This was a cross-sectional study, which was conducted at MOI. Two hundred and eighty patients who met the inclusion criteria were enrolled after obtaining written consent, data were collected using a structured questionnaire and Modified Lankester tool was used to recruit patients from the emergency department. Data were analyzed using SPSS version 21 computer software. Results: A total of 280 acute musculoskeletal trauma patients with a mean age of 28±15 years were recruited. There were more males 223(79.6%) than Females, Lankester group A accounted for 77.5% of the patients recruited. The mean waiting time for orthopaedic operation for Lankester A and B respectively was 9±5 and 12±6 hours while 65.4% for Lankester group A and 9.5% for Lankester had missed their target time. The majority of delays were due to lack of available operating time (43.3%) and the presence of comorbidities predicts delay of more than 24hours.

Conclusion: The study revealed the mean waiting time for patients who required emergency operation was 9±5 hours while for patients who required an urgent operation was 12±6 hours. Emergency patients operated less than 6hours after admission was only 34.6%. The commonest cause of the delay of operation was Lack of theatre slots while the presence of comorbidities predicts delay more than 24 hours

Recommendations: To allocate more theatre slots for emergency patients to reduce their waiting time. Orthopaedic and Trauma centers should use orthopaedic surgical treatment waiting time as the indicator for quality delivery services and a Physician should be part of the emergency on-call team to facilitate early management of patient's comorbidities.