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Concentration and Orthopaedic Services

Projects have been undertaken in NHS Forth Valley and Ayr and Arran examining the provision of orthopaedic services. A major challenge is to ensure a high utilisation of resources to reduce elective waiting lists and control costs while coping with a substantial emergency demand. Simulation was used to assess the impact on staff, bed and theatre time, quantifying the resource implications for a variety of scenarios. In particular, the studies explored the consequences for trauma services if Accident and Emergency departments were concentrated at one hospital in each area.


Bowers J and Mould G (2004). Managing uncertainty in orthopaedic trauma theatres. European Journal of Operational ResearchVol. 154, No.3, pp.599-608.

Bowers J and Mould G (2002). The deferrable elective patient: a means of reducing waiting lists in Orthopaedics. Journal of Management in MedicineVol.16, No.2/3, pp.150-158.

Bowers J and Mould G (2002). Concentration and the variability of orthopaedic demand. Journal of the Operational Research Society, Vol.53, No.2, pp.203-210.

Bowers J and Mould G (2001). What is the best size of unit for orthopaedic trauma services? British Journal of Health care ManagementVol. 7, No.10, pp.404-409.

Bowers J and Mould G (2001). Organisational implications of concentration of emergency orthopaedic services. Health BulletinVol.59, No.6, pp.381-387.

For further information please contact John Bowers.

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