Organisational implications of concentration orthopaedic services.

The re-organisation of the acute health services in 1999 is causing many acute trusts to consider the practical implications of concentrating services. This may be in terms of the complete merger of departments at different units or a less radical policy of the alternation of the responsibility for emergency receiving between units. The benefits may include the opportunity to improve the quality of care by providing more specialist services, more attractive working conditions with a larger pool of specialists providing the on-call rota and enhanced opportunity for training. Economic theory indicates that concentration should lead to economies of scale by greater sharing of fixed overhead costs, whilst statistical theory specifies that concentration should produce a relative decline in the variability of demand. This paper examines the effects of concentration on emergency admissions in an orthopaedic department by means of a series of simulation experiments. It examines the potential economies of scale for theatre utilisation and bed usage associated with increasing the volume of non-elective patients. As the volume of patients increases so the relative variability of demand decreases and the relative demand for emergency operating theatre time declines. Concentration could offer savings on theatre time allocated to trauma patients, but the impact on wards is less significant with concentration having a limited effect on the demand for beds.