Is it Financially Efficient to Lose the Ring-Fenced Elective Orthopaedic Ward?

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In an effort to rationalize National Health Service (NHS) funds in the United Kingdom, some hospitals have used the orthopaedic elective ring-fenced ward to admit general acute emergencies, admitting elective arthroplasty patients to general wards.


The aim of this study was to analyse the financial effect and length of stay of elective arthroplasty patients admitted to general wards rather than ‘ring-fenced’ orthopaedic wards.

Study Design

Retrospective observational study


Hospital care


During the period between 01 November 2010 and 31 March 2011, 194 consecutive patients were admitted for elective total hip and total knee arthroplasties. Due to increased bed pressures, 35 (18.04 %) of the patients were admitted to general wards instead of our standard elective ring-fenced orthopaedic ward. Data was collected and analysed for type of surgery, age, sex, length of stay, and ward.


The average length of stay in the general wards was 1.89 days longer (range 3–22 days; p < 0.001) than in the elective orthopaedic ward.


We conclude that losing the ring-fenced ward and admitting elective arthroplasty patients to general wards results in longer length of stay and a financial loss of 6.82 % per hip and knee arthroplasty patient.

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