title: An innovative and cost-effective way of managing ankle fractures prior to surgery--home therapy.
abstract: BACKGROUND
  Ankle fractures are common injuries affecting all age groups and constitute a large proportion of the orthopaedic trauma case load. Patients are usually admitted directly to the ward from the emergency department and a large number of bed-days are spent waiting for the ankle swelling to subside prior to surgery. We audited current practice and then implemented a home therapy programme (HTP). The purpose of the study was to assess the pioneering HTP with respect to cost effectiveness, length of stay and patient satisfaction.
  
  
  METHODS
  If HTP criteria were met, patients with reduced, unstable ankle fractures were taught safe mobilisation by physiotherapists in the emergency department. They were then discharged home to ice and elevate their ankle in a plaster backslab. A provisional operation date was allocated on discharge. They were admitted to hospital the day of surgery and then discharged home when safe and comfortable.
  
  
  RESULTS
  Forty-three consecutive patients met our inclusion criteria and underwent surgical fixation of unstable ankle fractures over a 3-month period (February-April 2008). The average length of hospital stay was 8 days (range, 1-18 days), 4.5 days pre-operatively and 3.5 days postoperatively. Patients were frustrated and dissatisfied with the whole process. In total, 177 patients underwent surgical fixation of unstable ankle fractures over an 11-month period (November 2008 to October 2009) and, of these, 59 met the home therapy criteria. The average length of hospital stay was 2.4 days, 1 day pre-operatively (range, 0-4 days) and 1.4 days postoperatively (range, 0-5 days). All HTP patients expressed satisfaction with the process. Over the course of the HTP, 354 bed-days were saved which equates to a saving of £81,774. The annual estimated cost saving is £90,000.
  
  
  CONCLUSIONS
  The home therapy programme has proved effective in reducing hospital stay both pre- and postoperatively. It is cost-effective and well received by patients.
authors.affiliation: Department of Trauma and Orthopaedics, Poole Hospital NHS Foundation Trust, Poole, UK.
authors.forename: John M
authors.initials: JM
authors.lastname: Lloyd
authors.forename: Rachel
authors.initials: R
authors.lastname: Martin
authors.forename: Senthil
authors.initials: S
authors.lastname: Rajagopolan
authors.forename: Nedal
authors.initials: N
authors.lastname: Zieneh
authors.forename: Richard
authors.initials: R
authors.lastname: Hartley
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004739:England; D005592:Fracture Fixation / Q000191:economics; D050723:Fractures, Bone / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000191:economics; D011300:Preoperative Care / Q000191:economics / Q000379:methods*