Urgent and planned orthopaedic surgery at imperial college healthcare nhs trust
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Urgent and planned orthopaedic surgery at Imperial College Healthcare NHS Trust. Management of fractures and degenerative disease of bones and joints e.g. ankles (29%), hips (23%), arms and shoulders (20%), legs (10%), and spinal injuries (8%). Operations are generally:

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Urgent and planned orthopaedic surgery at Imperial College Healthcare NHS Trust

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Urgent and planned orthopaedic surgery at Imperial College Healthcare NHS Trust


  • Management of fractures and degenerative disease of bones and joints e.g. ankles (29%), hips (23%), arms and shoulders (20%), legs (10%), and spinal injuries (8%).

  • Operations are generally:

    • Planned e.g. hip/knee replacements for osteoarthritis; or

    • Urgent e.g. trauma causing disrupted bone/soft tissue or bone crumbling

Orthopaedic surgery


  • Orthopaedic surgery accounts for only 7% of the 52,000 planned operations and 7.5% of the 20,000urgent operations performed each year at Charing Cross and St Mary’s Hospitals

  • Figures for Ealing residents in brackets

Orthopaedic surgery at ICHT


Case for change – efficiency and quality

  • Efficiency: increased demands

    • Older, heavier population needing orthopaedic procedures

    • Treating planned care patients in 18 weeks is more challenging

  • Quality: Separate facilities for planned and urgent care are recommended by Royal College of Surgeons:

    • reduce infection rates such as MRSA

    • improves care – surgeons specialising in certain types of operations

    • planned ops are not cancelled by urgent work

    • urgent work not delayed by planned work

    • facilitates training and research – more patients in trials


  • Major Trauma Centre geared up with trauma specialist orthopaedic consultant input. All urgent orthopaedic care on one site would facilitate timely treatment by specialist staff – improve outcomes

  • Day case facility larger capacity at Charing Cross than St Mary’s. If planned care all at CXH would allow greater proportion of day cases – reduced infection rates, more patient friendly.

  • Achieving single sex accommodation at both sites will be easier (no need for separation of elective and trauma for both sexes each site)

Case for change – specific to ICHT

  • Continuation with current inefficiencies make the service uneconomic.

  • Various options considered by clinicians


Preferred options with most benefits

  • Planned surgery at CXH and urgent surgery at St Mary’s

    • More day care (CXH day unit) – achieving better care and savings

    • Enables a critical mass of specialist orthopaedic trauma surgeons at StM

    • No conflict between elective and urgent duties

    • Most cost effective option: £1.2m capital

    • Clinicians’ preferred option

  • Planned surgery at CXH but urgent at CXH and SMH

    • More day care (CXH day unit) and improves planned care

    • Small capital cost

    • But does not improve urgent care


  • The 40,000 outpatient appointments should, and will, continue unchanged on both sites – there is no advantage to changing their location

  • The fracture clinics on each site should, and will, continue unchanged

  • Urgent medical and surgical services at Charing Cross including HDU/ITU will remain unchanged

What does not need to change?


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