The general manager responsible for orthopaedic services in a large acute NHS hospital has sought your advice regarding the kind of intervention that might be effective in helping to improve the treatment offered to patients who are admitted for trauma orthopaedic care.

Trauma orthopaedic care (which typically involve an emergency admission and immediate treatment for a condition such as a broken leg) and elective orthopaedic care (which involves non-emergency treatment such as a hip replacement operation) are provided by separate departments located in neighbouring hospitals within the same city. Because of a government initiative to reduce waiting times (that apply to elective treatments) extra resources have tended to be allocated to elective care rather than to trauma services. The situation confronting trauma orthopaedic care has worsened over the last three years because the department has had to cope with an 11 percent increase in emergency admissions. This has undermined the department's ability to provide the quality of care that it, and other stakeholders, believe patients should receive. While the hospital recognizes that trauma services are under resourced and has agreed to appoint more orthopaedic surgeons and increase their access to operating theatres, everybody recognizes that these changes will not be in place for some time. As a result, staff morale is low.

Several orthopaedic surgeons and departmental managers are highly motivated to change what they refer to as a ‘desperate situation' in trauma orthopaedic care. They are particularly concerned to improve patient care for one of the largest groups of patients, those admitted with a broken neck of femur. There are approximately 800 such admissions each year and the average patient stay is 24 days.

The department has a traditional structure with four wards, each headed by a ward sister (a senior nurse who acts as ward manager). Occupational therapists and physiotherapists work with patients to facilitate their rehabilitation. Doctors, nurses, occupational therapists and physiotherapists maintain their own care notes and treatment plans. Many patients with this condition are elderly and require support in the community post discharge. Social workers (who work for the Local Authority's social services department) assess this need and arrange social care packages.

•Design an intervention that will improve the situation in trauma orthopaedic care. This could include delivering outcomes such as improved patient care and reduced length of stay in hospital.

•Identify issues that might affect the success of your proposed intervention and explain how you would address these issues.