To audit and assess the cost effectiveness and patient satisfaction of an orthopaedic pre-admission clinic.

A pre-admission clinic for patients undergoing elective orthopaedic surgery has been in use in our hospital for the past 3 years. We audited the activities of this clinic over a period of 1 year and also assessed the cost effectiveness and patient satisfaction over the study period. Over 1 year, 2391 patients were invited and 2167 (90. 63 %) attended the clinic.

Patients’ satisfaction was assessed using a multidimensional questionnaire which included information on time spent with patients by doctors and nurses and communication, facilities, patient involvement and overall quality of the clinic. Patient cancellation and deferring of surgery was also calculated. Cost of bed blocking due to cancellation following admission and cost of theatre time was also calculated.

During the 1 year period, the non-attendance rate was 9. 37 % (224 patients). The cancellation rate following admission was 3. 4% (75 patients). 270 patients (11. 3%) had their surgery postponed due to medical and social reasons. Of the 2167 patients, 1822 (84%) had their surgery performed as scheduled. Thirty percent of the patients were unaware that they would be seen by both doctors and nurses. All the patients were satisfied with time spent with them and the information given regarding the surgery. 90% of the attending patients rated the service as excellent to good. Based on average cost of one night stay and overnight bed blocking and theatre time, this clinic has saved over £200, 000 for the Trust. The pre-admission clinic for elective orthopaedic surgery is not only cost effective but also reduces the ward-based workload for the junior doctors.

We studied 56 patients with fractures of the tibial shaft in a multicentre prospective randomised trial of three methods of external fixation. Group I was treated with a fixator which was unlocked at 4 to 6 weeks to allow free axial compression (axial dynamisation) with weight-bearing. Group II was treated with a fixator that was similarly unlocked at 4 to 6 weeks but included a small silicone spring which on weight-bearing could be compressed by up to 2 mm. this spring returns to its original length on cessation of weight-bearing thus allowing cycles of motion of up to 2 mm. Group III had a spring fixator like group II, but it was unlocked from the start to allow cyclical micromovement as soon as weight-bearing began. Fracture healing was monitored by the measurement of fracture stiffness. We defined healing as achieving a stiffness of 15 Nm per degree. The mean time was 14.1 weeks in group I, 15.9 weeks in group II, and 19.3 weeks in group III. The difference between groups was statistically significant (p = 0.004). The 95% confidence intervals for the average delay in healing with early cyclical micromovement (group III) as compared with later axial dynamisation (group I) was 1.8 to 8.7 weeks. The healing time in patients whose cyclical micromovement was delayed for 4 to 6 weeks (group II) was between these two extremes, but the differences from either of the other groups could have been due to patient selection. In the patients who completed the full trial, there were pin-track infections in over 60% of those in the cyclical micromovement groups compared with 20% in the axial dynamisation group (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)