Ankle Home Stay Programme:- A review of ankle fracture management and costs at a busy district general hospital

INTRODUCTION: Patients suffering ankle fractures provide a common economic and time burden to modern healthcare in the UK. They continue to be admitted to await operative intervention and may have to wait days before an operation occurs. Unnecessary bed stay is one are that may be subject to cost savings if the safety of the patient is maintained. PATIENT AND METHODS: We prospectively collected data on 23 patients over a four-month period identifying their admission status, length of stay, and time to operative intervention. We were able to cost analyse the patients journey from admission to discharge, postoperative intervention. We then instilled the Ankle Home Stay Programme, identifying patients safe to be discharged who were able to re-attend for their operation. Seventeen patients were enrolled in this and a subsequent cost-analysis was compared to the pre-intervention cohort. RESULTS: Pre Ankle Home Stay Programme demonstrated cost per patient of admitted patients to be £2690 and £1347 for patients managed in the outpatient setting. Implementation of the pathway maintained this cost saving with those in the outpatient setting costing £1781 per patient and those admitted costing £2855. CONCLUSIONS: Patients can be safely managed in the outpatient setting, with regular clinic review before formal operative intervention as opposed to blanket admission to an acute inpatient bed. This is cost saving in a healthcare system with finite resources focussed on improving use of economic resources. It also maintains patient care with select admission criteria onto the pathway and regular review to ensure standards are maintained.