Relieving Pressure on the Emergency Department with a New Treatment Pathway for Hand Trauma Patients - A Three-Year Experience with 15,539 Patients.

Hand injuries are a significant and rising burden on the Emergency Department (ED), often leading to protracted waiting times for patients awaiting specialist input. To combat this, a new treatment pathway for hand trauma was introduced at our institution to reduce waiting times and pressure on the ED. The treatment pathway performance using waiting times, length of stay and cost metrics was measured prior to and following the introduction of a new treatment pathway. There were 15,539 patients reviewed in total. After the new pathway had been introduced, the number of assessments in ED significantly reduced (Year 1: 907 [19.9%] vs. Year 2: 422 [7.9%]; < 0.001), and the proportion of patients who had an operation on the same day that they were assessed significantly increased (69 [1.5%] vs. 403 [7.5%] patients; < 0.001). The median waiting time from assessment to operation and length of stay also significantly reduced following the introduction of the treatment pathway (Year 1: 53 hours and Year 2: 45 hours; < 0.001). Our data over 3 years shows that these changes have been maintained and, in some cases, have continued to improve since the introduction of the new treatment pathway. We advocate the use of such an approach for all hand trauma centres worldwide to replicate these improvements in patient care. Level III.