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Trust me stick together, strict criteria that you endorse and cancel if
ring fence is breached, do not compromise. It's the only language they understand. It's the only way it works.
This is the usual story.
Ring Fenced beds with 'criteria' to admit non-joint patients do not work for more than a week. The only way is to separate the elective and trauma sites, which fortunately is the case in some trusts, though not by design but by default.
We are struggling to create a small 'implant unit', but with a very small bed-base, which will lead to cancellations due to bed shortage.
BOA & Prof. are advocating 'elective wards', but not many trusts can afford that, more so in absence of any strong evidence on infection rate.
Will keep you all informed what happens.
We had ringfenced elective elective beds in Swindon from 1995 to last year when we lost 12 elective ortho beds (“sold” to create a too small trauma ward, so the medics could have our original 36 bed trauma unit) and pure elective ortho surgery ward status such that we have to accept mrsa –ve swabbed patients with:
Isolated msk trauma up to tibial nail magnitude
Elective breast, thyroid, ent and eye surgery
Avg no of outliers = 3 /24 beds
All of these patients go into side wards, which are terminally cleaned after non-ortho use
We were all very much opposed to this change, but it was nonetheless imposed. We were also opposed to downsizing our trauma unit.
We stated the clinical risks to no avail.
I’m still very concerned particularly about the ent patients, but they still pop up maybe x1 per month
The bed base in our hospital is too small to fully preserve the pure elective ward, and there is limited will or sympathy (+ ignorance of the consequences of implant sepsis) from other services, but I would like to get back to pre-2014.
We’ve had x2 protocol breaches (medical patients) in 18 months when I’ve shut the ward to further admissions.
Thankfully thus far no perceptible increase in infections. Fingers remain x’d.
Same as below in Aintree.
In Crewe, same as Airdale. We tell management and not the other way round. Patient safety and acute awareness of cost of infected revisions are usually good bargaining tools.
Breach of ringfence = cancelled elective activity until ward clear and deep cleaned. Happened twice last year due to no choice with significant loss of revenue.
Clinical Lead in Trauma and Orthopaedics
Mid Cheshire Hospitals NHS Foundation Trust
No outlying specialities. No acute orthopaedic admissions. Any tramua patients decamped onto elective ward are selected by Consultant teams as apporprite post op, MRSA negative proven and documented(#NOF for THR, ankles post-op usual crown). No wet wounds, UTI, Chest inefctions, Frames. No #NOF except trauma THR which are often home in 2-3 days like an elective anyway.
Any breaches to the ring-fence = cancellation of elective activity until resolved and deep cleaned.
It's a lot easier to manage as a "black and white" system for all. It only works when everyone works together to achieve without exception so a cohesive apporach from all orthopaedic colleagues is vital.
CD Airedale Hopitals NHS Foundation Trust
We have a “protected” ward for elective orthopaedic admissions, but due to fluctuating bed requirements from our department and pressure from elsewhere we have rules in place that allow pre-screened clean general surgical cases (eg breast or hernia surgery) to sometimes use beds, and acute patients admitted from own home deemed low risk can be admitted to a side room and rapid screened for MRSA before then being allowed on the ward (both orthopaedic and surgical / gynae)
The GIRFT report recommends “ring-fenced beds” but is not totally specific about what this means. We want to exclude other surgical and medical teams as much as possible (even with “clean” patients) from the ward to limit footfall, but are not being supported in doing this by our infection control team.
What are your criteria for ring-fencing elective orthopaedic admissions?
If the criteria are breached, what happens?
Mr Ben Lankester
Yeovil District Hospital