Discharging patients with ankle fractures prior to surgery
| ISRCTN | ISRCTN94661773 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN94661773 |
| Secondary identifying numbers | Ankle Audit |
- Submission date
- 16/01/2019
- Registration date
- 17/02/2019
- Last edited
- 16/01/2020
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Injury, Occupational Diseases, Poisoning
Plain English summary of protocol
Background and study aims
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. We hypothesise discharging patients with adequate information and follow up using expedited outpatient clinics can create huge efficiency savings for hospitals who would otherwise admit these patients and wait for the swelling to subside prior to operating.
Who can participate?
All adult patients (greater than 16 years) of either gender who have sustained ankle fractures requiring definitive fixation.
What does the study involve?
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.
What are the possible benefits and risks of participating?
Participants can be discharged to the comfort of their own home. No such side effects exist as the practice already exists.
Where is the study run from?
Lewisham Hospital.
When is the study starting and how long is it expected to run for?
February 2014 to July 2014
Who is funding the study?
Investigator initiated and funded.
Who is the main contact?
Langhit Kurar
Langhitkurar@nhs.net
Contact information
Scientific
120 Woodside Road, Amersham
Buckinghamshire
HP6 6NP
United Kingdom
| Phone | 07866596096 |
|---|---|
| langhitkurar@nhs.net |
Study information
| Study design | Observational cohort |
|---|---|
| Primary study design | Observational |
| Secondary study design | Cohort study |
| Study setting(s) | Hospital |
| Study type | Other |
| Participant information sheet | No participant information sheet available. |
| Scientific title | Ankle Home Stay Programme: an observational cohort studying reviewing ankle fracture management and costs at a busy district general hospital |
| Study objectives | Discharging patients with ankle fractures requiring surgical intervention is more cost effective than admitting them with no net effect on patient safety. |
| Ethics approval(s) | No ethics approval required as this was an observational study on practice that already exists in the hospital. |
| Health condition(s) or problem(s) studied | Ankle fracture |
| Intervention | From acute presentation to accident and emergency with an ankle fracture patients were examined by the on call orthopaedic team and a decision for surgical fixation was made. If not appropriate for surgery patients were discharged and followed up routinely in the fracture clinic. If the fracture warranted surgery and there was reasonable opportunity to operate within 24 hours (e.g. swelling minimal) patients were admitted onto the ward. If the patient was safe for discharge – abiding by parameters mentioned in the paper – there were followed up in a fast tracked orthopaedic outpatient clinic to be assessed for degree of swelling. If reasonable they were then admitted from clinic rather than occupy a hospital bed indefinitely waiting for the swelling to go down. This was more cost effective and saved the trust large sums of money. This audit was conducted over a 4 month period as mentioned previously. |
| Intervention type | Other |
| Primary outcome measure | Cost efficiency savings were measured using cost of admission, number of days admitted with direct correlation to the cost of managing patients in an outpatient setting (e.g. fracture clinic). |
| Secondary outcome measures | The number of hospital inpatient days were measured using patient notes. |
| Overall study start date | 01/02/2014 |
| Completion date | 31/12/2016 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | 23 |
| Total final enrolment | 23 |
| Key inclusion criteria | Acute ankle fracture requiring surgery |
| Key exclusion criteria | Ligamentous injury |
| Date of first enrolment | 01/03/2015 |
| Date of final enrolment | 31/07/2015 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centre
London
SE13 6LH
United Kingdom
Sponsor information
Hospital/treatment centre
Lewisham High Street
Lewisham
London
SE13 6LH
England
United Kingdom
| Phone | 020 8333 3000 |
|---|---|
| langhitkurar@nhs.net | |
"ROR" |
https://ror.org/04vgz8j88 |
Funders
Funder type
Other
No information available
Results and Publications
| Intention to publish date | 01/02/2019 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | Intending to publish resulst of study as soon as possible. |
| IPD sharing plan | Raw data available on request from from Amit Patel (Amit.Patel2@gstt.nhs.uk). |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | results | 01/02/2020 | 16/01/2020 | Yes | No |
Editorial Notes
16/01/2020: The following changes have been made:
1. Publication reference added.
2. The final enrolment number has been added from the reference.
