Abstract
Introduction
The concept of the golden patient (GP) was introduced to our busy teaching district general hospital, in April 2009, to improve trauma theatre start times following disappointing results from a previous in-hospital study. The GP is a pre-selected first patient on the following day trauma list who is medically fit with a clear surgical plan. The GP should have already been seen by an anaesthetist and be ready to be sent for by theatres early. It has been shown by others to improve operation start times and could be used to improve trauma services and meet clinical targets more readily.
Methods
This prospective study involved the collection of planned trauma lists with the designated GP over November and December 2009. Data was collected from the theatre logbooks, including patient demographics, theatre reception, anaesthetic and operation start times. This was compared with the pre-GP data (January and February 2009). Graphs showing the comparative mean start times between pre-GP and GP trauma lists, including the 95% confidence interval for the population mean were created. A two sample T test was used to evaluate significance between groups.
Results
Of the 55 planned trauma lists analysed, 42 had a designated GP on it (76%), 37 of which remained first on the actual trauma list (88%). The mean theatre reception arrival time for the pre-GP lists was 09:25 compared to 09:01 for the actual GP lists (P<0.001). The mean anaesthetic start time for the pre-GP lists was 09:35 compared to 09:09 for the actual GP lists (P<0.001). The mean operation start time for the pre-GP lists was 10:03 compared to 09:33 for the actual GP lists (P<0.001); the mean operation start time was reduced by 30 minutes if the GP remained first on the trauma list. The reception, anaesthetic and operation start times for pre-GP lists compared with lists where no GP was selected were not statistically significant suggesting that the GP was the cause of the significance. The mean anaesthetic review time was 08:31.
Conclusion
The concept of the GP has made a significant improvement to theatre start times. By implementing the GP for each trauma list and obtaining a timely anaesthetic review our research indicates that the times could be improved by a further 31 minutes, resulting in a 61 minute improvement in overall operation start times. The GP has benefitted orthopaedic surgeons, anaesthetists, theatre staff and importantly patients. A more planned approach has improved efficiency and taken the stress away from organising and conducting a trauma list. Our experience supports this concept being used widely to improve trauma care in the UK setting.
