An analysis of factors contributing to delays in surgery at a level 1 trauma center prior to implementation of a dedicated orthopaedic trauma room

Background: The benefits of a dedicated orthopaedic trauma room (DOTR) include improvements in efficiency and cost reduction; however, many hospital systems do not implement them, possibly due to perceived financial or volume considerations. The objective of this study was to analyze the factors contributing to delays in surgery at a center without a DOTR to aid in removing barriers to implementation. Methods: A retrospective review from October 2021-September 2022 was conducted at a single Level I trauma center utilizing an “add-on” model of surgical scheduling for non-elective cases. Primary outcome measures included: time from admission to surgery, time from clearance to surgery, number of rescheduled surgeries, and reasons for surgical delays or cancellation. Results: 581 “add on” orthopaedic trauma procedures were identified. The median time from admission to surgery was 15 hr (mean 29.5). The median time from clearance to surgery was 8.24 hr (mean 12.5). 479 (82.4%) cases arrived in the preoperative holding area without delay. 117 of our 581 total patients (20.1%) were rescheduled either prior to or after reaching the preoperative area due to room availability and 56 (9.6%) were rescheduled due to other medical reasons. Conclusion: Patients are typically optimized for surgery, but a significant cause of surgical delays is room availability. Time from clearance to surgery accounts for over half the time from admission to surgery. In conjunction with the economic and efficiency benefits, this information may assist practice managers in making informed decisions regarding implementation of a DOTR.