Mr Tom Walsh1,2, Dr Linda Ferris1, Dr Nancy Cullen1, Dr Christopher Brown2, Ms Cathy Loughry3, Dr Nikki McCaffrey4
1The Queen Elizabeth Hospital, Woodville South, Australia, 2The Repatriation General Hospital, Daw Park, Australia, 3Central Adelaide Local Health Network, Adelaide, Australia, 4Deakin University, Burwood, Australia
The aim of this study was to evaluate the cost-consequences of a podiatry-led triage clinic provided in an orthopaedic department relative to usual care for non-urgent foot and ankle complaints in an Australian tertiary care hospital.
All new, non-urgent foot and ankle patients seen in an outpatient orthopaedic department were included in this study. The patients seen between 2014-2015 by Orthopaedic Surgeons were considered ‘usual care’, the patients seen between 2015-2016 by a Podiatrist were considered the ‘Podiatry Triage Clinic’. Data on the new : review patient ratio, the number of patients discharged; surgical conversion rate; staff time; and imaging use were collected. A cost-consequences analysis, undertaken from a healthcare provider perspective (hospital) estimated the incremental resource use, costs and effects of the Podiatry Triage Clinic relative to usual care over a 12-month period.
The Orthopaedic Surgeons and Podiatrist consulted with 72 and 212 new patients during the usual care and triage periods, respectively. The total integrated appointment cost for the 12-month usual care period was $32,744, which represented a cost of $454.78 / patient. The total appointment and imaging cost during the triage period was $19,999, representing $94.34 / patient. Further analysis, suggests that the projected annual saving of integrating a Podiatry Triage Clinic versus an orthopaedic clinic alone is $50,441.
The integration of a Podiatrist into an orthopaedic department greatly increases the number of patients seen, is cost-effective, improves the surgical conversion rate and improves the utilisation of Orthopaedic Surgeons.
Tom Walsh is a podiatrist and PhD candidate from Adelaide. He works in both the public and private sector. His research interests include the interaction of obesity and foot pain. His clinical practice predominately involves the management of musculoskeletal foot disorders.