{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T03:41:05Z","timestamp":1709350865747},"reference-count":13,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2015,12,3]],"date-time":"2015-12-03T00:00:00Z","timestamp":1449100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The hand surgery service in our major trauma centre comprised predominantly emergency surgery with poor theatre access, resulting in many cases being postponed and performed after hours and with low rates of supervision.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We report the results of a before\u2010and\u2010after study describing the change in processes and outcomes associated with a change in the model of care to a sequestered, area\u2010wide hand surgery service. The study uses data from 12 months prior to and 12 months after the change in practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The hand service experienced a 24.7% increase in demand for surgery in the first 12 months after the relocation. However, demand for overnight beds fell by 303%, the rate of specialist supervision increased from 23.5% to 81.3% (<jats:italic>P<\/jats:italic> &lt; 0.0001), the time between admission and surgery fell from 5.1 to 2.7 h (<jats:italic>P<\/jats:italic> &lt; 0.0001), the rate of cancellations fell from 21.8% to 7.7% (<jats:italic>P<\/jats:italic> &lt; 0.0001), the proportion of emergency surgery conducted in normal hours increased from 65.8% to 93.6% (<jats:italic>P<\/jats:italic> &lt; 0.0001), the 28\u2010day unplanned reoperation rate fell from 1.2% to 0.5% (<jats:italic>P<\/jats:italic> = 0.02) and surgical time decreased to an equivalent of 41 half day operating sessions per year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These outcomes are in line with international experiences of service centralization. The project may be used as a template for practice change in other surgical fields.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.13395","type":"journal-article","created":{"date-parts":[[2015,12,3]],"date-time":"2015-12-03T07:52:44Z","timestamp":1449129164000},"page":"581-583","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving hand surgery access and care through service redesign"],"prefix":"10.1111","volume":"86","author":[{"given":"Grant","family":"Isedale","sequence":"first","affiliation":[{"name":"Critical Care &amp; Surgical Specialties Clinical Stream South Western Sydney Local Health District  Liverpool New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Harris","sequence":"additional","affiliation":[{"name":"South Western Sydney Clinical School, University of New South Wales Ingham Institute for Applied Medical Research South Western Sydney Local Health District  Liverpool New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Rider","sequence":"additional","affiliation":[{"name":"South Western Sydney Hand Centre Fairfield Hospital  Prairiewood New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,12,3]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Injury in Australia: A Snapshot 2004\u201005","author":"Australian Bureau of Statistics","year":"2006"},{"key":"e_1_2_6_3_1","volume-title":"Work Related Hand and Wrist Injuries in Australia","author":"Australian Safety and Compensation Council","year":"2008"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588409X432338"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2010.0246"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X13519796"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2015.02.036"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2012.11.001"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.01.033"},{"key":"e_1_2_6_10_1","first-page":"65","article-title":"Impact of the introduction of a daily trauma list on out\u2010of\u2010hours operating","volume":"81","author":"Jennings A","year":"1999","journal-title":"Ann. 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