THE ECONOMIC GAINS ACHIEVED BY A SIMPLE CHANGE IN POST OPERATIVE CASTING PROCEDURE

Abstract

Introduction: In June 2006, the post-operative plaster immobilisation protocol for patients undergoing foot and ankle surgery at our institution changed from multiple plaster changes to the immediate application of a definitive reusable split synthetic cast. This study aims to assess the savings following this change in practice.

Materials and Methods: A retrospective analysis of plaster room records from June 2005 to June 2007 was performed.

The original procedure involved application of a plaster backslab following surgery, change of cast on day 1 post operatively, suture removal and plaster change at two weeks post-operation and cast removal or bivalving six weeks post-operation, following outpatient review.

The new procedure utilised a reusable cast applied in theatre which allowed suture removal and wound inspection in the community and outpatient review at six weeks without plaster change.

Results: Two hundred and twenty-two patients from 2005–6 were managed with the plaster procedure at a cost of £344.98 per patient and a total cost of £76,586.56. While 203 patients from 2006–7 were managed with the new procedure at a cost of £147.10 per patient and a total cost of £29,861.30. The net saving to the hospital of this change in practice was £197.88 per patient and £40,169.64 in total. There were no referrals back to the hospital as a consequence of this change in practice.

Discussion: Plaster changes and hospital outpatient appointments add cost to surgical procedures. This simple change in the post-operative casting of foot and ankle patients resulted in less outpatient visits and plaster changes without compromising the standard of medical care.

Conclusions: In the current political and financial climate it is important that economic efficiency, at a local level. This study demonstrates how small changes in local practice can result in significant financial savings for hospitals.