Concentration and the variability of orthopaedic demand

Concentrating health services with centres providing selected, specialist care offers a number of potential advantages. The benefits may include the opportunity to improve the quality of care by providing more specialist services and greater expertise, more attractive working conditions with a larger pool of specialists providing the on-call rota and an enhanced opportunity for training. Concentration will produce greater volumes of patients in the selected specialties with the possibility of various economies of scale. A series of simulation experiments explored the potential for efficiencies associated with the increasing volume of non-elective patients in an orthopaedic specialty. As the annual volume of patients increases so the relative variability of the demand for operating theatre time declines: concentrating non-elective orthopaedic activity could offer considerable savings in the theatre time allocated to trauma patients. However, the impact on the wards is much less significant, with concentration having a negligible effect on the requirement for beds.