The integration of a Podiatrist into an orthopaedic department: a cost‐consequences analysis

Abstract

BackgroundThe 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.MethodsAll new, non-urgent foot and ankle patients seen in an outpatient orthopaedic department were included in this study. The patients seen between 2014 and 2015 by Orthopaedic Surgeons were considered ‘usual care’, the patients seen between 2015 and 2016 by a Podiatrist were considered the ‘Podiatry Triage Clinic’. Data on new and review patient appointments; the number of new patients / session; the number of appointments / patient; the number of patients discharged; the 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.ResultsThe Orthopaedic Surgeons and Podiatrist consulted with 72 and 212 new patients during the usual care and triage periods, respectively. The Podiatrist consulted with more new patients / session, mean (SD) of 3.6 (1.0) versus 0.7 (0.8), p < 0.001 and utilised less appointments / patient than the Orthopaedic Surgeons, mean (SD) of 1.3 (0.6) versus 1.9 (1.1), p < 0.001. The percentage of patients discharged without surgery was similar in the Podiatry Triage Clinic and usual care, 80.3% and 87.5% p = 0.135, respectively, but the surgical conversion rate was higher in the Podiatry Triage Clinic, 76.1% versus 12.5% p < 0.001. 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.ConclusionsThe integration of a Podiatrist into an orthopaedic department significantly increases the number of patients seen, is cost-effective, improves the surgical conversion rate and improves the utilisation of Orthopaedic Surgeons.

Management of musculoskeletal foot and ankle conditions prior to public‐sector orthopaedic referral in South Australia

“…Some health networks have implemented innovative management strategies in response to the expansion of waiting‐lists and the poor surgical conversion rate. Podiatrists, providing non‐surgical interventions or education, working with an orthopaedic department have efficiently discharged patients from orthopaedic waiting‐lists across Australia [11, 13, 14]. The success of these clinics is important, but it raises further questions as to why these patients were referred to an orthopaedic department in the first place.…”

The Opportunity for Impactful Integration of Vascular and Podiatric Care

“…However, it remains important to acknowledge that while the concept of integrating vascular surgery and podiatry has made impressive strides, it is not a universally embraced practice across all healthcare institutions. In some instances, podiatry may find itself aligned within different hospital departments, such as orthopedic surgery [24], thereby giving rise to a potentially intricate landscape of overlapping interests in the provision of foot and ankle services [25][26][27][28]. Consequently, there may be potential challenges regarding clinical practice patterns, consultations and coverage, call schedules, and financial incentives.…”

Understanding Patient Preference of Providers to Treat Foot and Ankle Disorders

“…Additionally, this allows for an increased number of patients seen and further surgical-utilization of orthopedic surgeons. [7][8][9] In an outpatient setting screening for surgical candidacy, as many as two-thirds of orthopedic patients were able to be removed from an orthopedist's waitlist by a DPM. This decrease in clinical duties of orthopedic surgeons allows for the opportunity to pursue higher surgical volume.…”