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Use of a "Hand Hub" for Local Anaesthetic Hand Trauma at University Hospitals Dorset

Greg Neal-Smith

Gregory Neal-Smith, Mohamed El-Taher, Bassem Michael, Joanna Higgins
University Hospitals Dorset, Poole, United Kingdom



Many procedures required for hand trauma can be performed under local anaesthetic in a procedure room. In UHD pre-2024, almost all were performed in a main theatre, with 94% under general anaesthetic, and often with a delay to theatre. The senior author developed a "Hand Hub" for cases amenable to local anaesthetic, to be performed within 4 days of injury, in a clinic-style procedure space. We present our early results.


We collected our data from all hand and wrist procedures from Nov 22 to Aug 23 as part of the RCSEng/BSSH collaborative QI project, HandsFirst. This formed the evidence for the change required and the senior author built a case for a physical space to be allocated for the Hand Hub. A proof of concept clinic was developed and run in Jan 24, with a Standard Operating Procedure, and formal space allocation thereafter. The Hand Hub has continued to run twice per week. The data was subsequently collected from Jan 24 to Apr 24.


There were 45 patients who underwent a procedure in the Hub. All procedures were performed under local anaesthetic. A total of 19 main theatre sessions were re-allocated to main trauma, improving our time to theatre for our larger trauma and hip fracture patients. There was no increase in infection. Positive feedback was received from all patients.


The introduction of the Hand Hub has significantly changed our practice, improved waiting times across the service, reduced waste, upskilled staff and improved patient experience.