SIMULATION PROGRAM FOR OPTIMAL ORTHOPEDIC CALL - A MODELING SYSTEM FOR ORTHOPEDIC SURGICAL TRAUMA CALL

This report uses a mathematical modeling system to define optimal orth opedic coverage for trauma centers. Data from 2,325 patients treated w ith emergency orthopedic operations within 24 hours of admission at 78 randomly sampled and at four totally sampled verified centers were us ed to create a profile of (1) admission by month, day, and hour; (2) o peration times; and (3) operation duration, The reason for operation i ncluded (1) open fracture or crush (809 patients); (2) irreducible dis locations (164 patients); (3) fracture with vascular injury (seven pat ients); (4) dislocation with vascular injury (17 patients); (5) compar tment syndrome (11 patients); (6;) femoral neck fracture in young pati ents (36 patients); (7) combination of categories 1 to 6 (70 patients) ; (8) fracture with multiple injuries (171 patients); and (9) urgent n ot emergent (1,040 patients). The program defined the frequency that a n injured patient needing an orthopedic consult would wait beyond 30 m inutes because the orthopedic surgeon was doing a trauma related opera tion at a center with one or two orthopedic surgeons on call. The prob ability that a patient cannot be seen promptly by one orthopedic surge on in a center doing 25, 50, 75, 100, 200, and 300 emergency procedure s per year is 0.17, 0.74, 1.6, 3.1, 12.5, and 28 patients per year. Wh en two are on call, 1.3 patients, yearly, will wait more than 30 minut es in a center doing 300 emergency procedures. Thus, mandatory orthope dic backup call for a trauma center performing fewer than 100 emergent trauma procedures within 24 hours is unwarranted.